Biopsy Results and treatment concerns

Your choices are too many to choose from for treatment. Your weight loss could be concerning unless you dieted and made this happen. Is this localized is a question to ask? This would determine type of treatments. Hope other responses are better than mine . Your still rather young.

Thank you. It is still localized. I am a slight 5'8" and usually 140 lbs - skinny guy- no diets. My age and need to keep going has me reluctant for treatment. The new tumor showed up in 18 months and that seems kind of quick...

Thank you for the help and comments. Good Health to You.

Hello, sorry for your biopsy results. But the good news is that you seem to be in the intermediate category and there should be options. You should seek out multiple professional opinions and I encourage you to go to a national center of cancer excellence if possible. Having experienced doctors can make a big difference.

I also had a new, more aggressive lesion show up within about 10 months from previous MRI and biopsy. I was also 3+4=7, perineural invasion, family history of disease, with cribiform glands (not seen until post surgery pathology report). I ended up choosing a robot assisted radical prostatectomy and am now 12 days post procedure. I spent a couple of months trying to walk as much as possible and doing kegel exercises to strengthen the pelvic floor. I'm doing great so far and actually peeing like a teenager. I was offered radiation but the oncologist said that with my enlarged prostate, I would likely have issues with retention due to swelling from the treatment.

Take your time and gather as much information as you can. Everyone is different. You'll make the right decision for you.

I was 3+4 and did the radical prostatectomy robotic surgery in 2018. Caveat ED and incontinence. First year with Kegel for incontinence and Penile injections got better. 2 years later i had aBoston Scientific male sling implant surgery reducing incontinence to almost 100%.

I was 70 a year ago when I had NS RARP at a center of excellence. I second @happydappy's comment about going to a (NCI recognized) CCOE (there's a list on NCI's website) if that's an option for you. I was 5'11" 186 lbs at the time of surgery. I was continent immediately after the catheter came out although I did have some minor urine releases as I figured out the new normal. Without my old BPH prostate I pee like I'm 30 years younger. I did have significant ED right after surgery, with it slowly getting better and being mild ED at 1 year, which means I can again engage in intercourse (although not quite as good as before). In my case, the pathology of the prostate after surgery found both cribriform and IDC present, so I was pretty glad I got it out when I did as the margins were clean and no detectable cancer outside the prostate. I started Kegels about a month before surgery and continue them (although less frequently) to this day. Best wishes.

Your biopsy doesn’t look too bad, The issue is the cribriform Found in the two 3+4’s. Cribriform is hard to treat with SBRT (cyberknife) Can’t always remove it completely. They say that you need brachytherapy after SBRT to really knock it down. Or you can do surgery. Some of this depends on whether it is large cribriform meaning over .25 mm. If it is large cribriform Then it’s equivalent to having a five in your Gleason score.

Your doctors may discuss active surveillance as an option with you, but with that cribriform it may not be the safest option.

Thank you all. I hope you are all finding healthy days for a long while into the future.

(With a localized, 7(4+3), PSA of 7.976, (and at 65y), I chose 28 sessions of proton radiation w/6 months of Eligard. Had proton treatments during April-May 2021; Eligard injections in April & July 2021. PSA now varies between 0.35-0.55; most recent PSA (last month) was 0.473. I chose not to have a prostatectomy because there was no medically-necessary reason for surgery.)

> You mentioned that “The first tumor is new since the last biopsy (18 months ago).” Is it a new tumor or was it just too small to see previously?

> For localized prostate cancer, data indicate the success rates between prostatectomy or radiation are statistically equivalent. The decision comes down to what side/after-effects are you willing to deal with?

> No need to be “Annoyed by this diagnosis”; it happens. Of course you’ll pursue treatment. It’s not a factor of how fit you are, daily activities, etc. The primary risk factor for prostate cancer is age - average age at diagnosis is 66y. At 63y, you’re right near the target zone…….

Regarding your biopsy results:
> It’s the highest Gleason score that matters. Yours is 3+4=7. Also referred to as Grade Group 2 or “intermediate favorable”.

> The Cribriform pattern (for the pattern “4” cells of the Gleason score) matters as well. Cribriform pattern is often an indicator of more aggressive disease.

> A percentage of Pattern 4 of 20% is of interest, but it’s still on the low end.

> Perineural invasion (PNI) is also of interest, and can be an indicator of concern.

A few other factors that would help you to know:
> What is your PSA? What was your PSA Doubling Time?

> What were your MRI results? Any mention of seminal vesicle invasion or extracapsular (or extraprostatic) extension?

> In addition to the Decipher results (that you’re waiting for) you should also request a PSMA PET scan.

With that additional information, you’ll have the basic information needed to begin down the path of making a treatment decision.

You’ll do fine.

Thank you. I appreciate the reply and information.

The tumor is new. I asked largely the same question and my doctor was very clear... It's new. My PSA has never been all that high. The last 30 months the range is 3.9 - 4.7. No seminal vesicle invasion or extraprostatic extension noted in the biopsy notes.

My doctor did spend a fair amount of time talking to me about Cribiform as have several of you all on this site.

PSMA PET scan on my list to request - thank you.

Thank you - good Health to You.

Excellent; sounds like you’ve got things covered and have a good patient-doctor relationship.

The reason I asked if it was actually a new tumor was because in my case, my first two biopsies were “blind” biopsies. Later with an MRI-guided biopsy they found a lesion. So, I’ll never know if that was a new lesion or one that the “blind” biopsy simply missed.

Mayo Clinic utilizes age-specific reference ranges for PSA tests to assess prostate cancer risk, with higher levels considered more suggestive of cancer in older men. Your PSA appears to have been in that range. (Even though prostate cancers can occur with lower PSAs.)