Gleason 8 diagnosis at 51: Likely opting for surgery

Thanks!

I posted this twice because the first time I forgot to hit reply.

Info on what you’re looking for

After ambiguous results the pathologist suggested a second opinion. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring

Dr. Epstein Has opened his own second opinion practice in New York City.

World-renown uropathologist Jonathan Epstein, MD, has launched details about his new practice Advanced Uropathology of New York: Global Consultation Services in New York City.

Advanced Uropathology is affiliated with Integrated Medical Professionals, PLLC, (IMP) (https://www.imppllc.com/about-imp-2/), a subsidiary of Solaris Health. http://www.solarishealthpartners.com,.

He charges a consultation fee of $450. Sign up for a consult here: https://advanceduropathology.com/consultation/

Info on what you’re looking for

After ambiguous results the pathologist suggested a second opinion. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring

Dr. Epstein Has opened his own second opinion practice in New York City.

World-renown uropathologist Jonathan Epstein, MD, has launched details about his new practice Advanced Uropathology of New York: Global Consultation Services in New York City.

Advanced Uropathology is affiliated with Integrated Medical Professionals, PLLC, (IMP) (https://www.imppllc.com/about-imp-2/), a subsidiary of Solaris Health. http://www.solarishealthpartners.com,.

He charges a consultation fee of $450. Sign up for a consult here: https://advanceduropathology.com/consultation/

Different question: Does anyone know who are good contacts for a second reading of my mpMRI and possibly PSMA? There are websites, but I am hesitant since you cannot know who they will send it to. I eould want someone very expetienced.

Brian thanks so much for finding time to write such detailed response and for including links for lodging and all - I am very grateful and your post gives me much hope in general. My husband has almost exact PSA (his is 7.5) , Gl. i 4+3 but unfortunately he has some duct involvement 🙁 and some cribriform but we will see what PSMA PET CT shows and also second and third pathology consult that will hopefully happen soon.

Prior to the three current PSMA PET scans (tradenames Illuccix, PYLARIFY, and Posluma), there were a number of PET scans that didn’t rely on PSMA. Some are still backups in case PSMA doesn’t work:
> F18-Fluciclovine —> Axumin® is the go-to these days other than PSMA. (Insurance still covers it.) Axumin doesn’t rely on PSMA. Axumin works by exploiting the fact that prostate cancers absorb amino acids at a much more rapid pace than normal cells. Axumin is made up of a radioactive tracer linked to an amino acid. Cancer cells absorb the amino acids more avidly than normal cells, so when Axumin is used, the radioactive tracer concentrates inside the tumor cells. When the patient is imaged, the areas that have a high concentration of the imaging agent signal the location of the cancer in the patient’s body.
> Choline C11–> works well for detecting prostate cancer; not sure who besides Mayo used it.
> F18-FDG —> Didn’t work so well for detecting prostate cancer (unless the cancer was very advanced); but, it did great for detecting lung and brain cancers which are more avid for sugar (glucose).
> F18-NaF —> worked well for detecting prostate cancer, but not sure if insurance still covers it.

You might consider asking your medical team what scan they use as backup if PSMA doesn’t see any known cancers.

I had my proton radiation treatments during April-May 2021 (with 6 months of Eligard and SpaceOAR Vue injected).
> Side-effects from the proton radiation —> I only had 1 day of adverse side-effects during my 28 sessions of proton beam radiation treatments. On the 3rd day of treatment, I had urinary issues. My RO told me that with some men there’s an inflammatory response to the radiation, and if that inflammation is near the urethra can cause the issues that I was experiencing. He recommended that I take 2 Tamsulosin/day for the remainder of the treatments. Everything cleared up by the next day; I haven’t had any issues since. My “recovery” from radiation treatments was uneventful. (My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. The short amount of time that I was gone each day for treatment were no different than any other time when I simply left to go shopping or to the gym.)
> There are currently 46 operating proton centers in the U.S.: https://www.proton-therapy.org/map/
> If you have to travel for treatments, Hope Lodge communities across the country provide a free place to stay during treatment so people with cancer can focus on getting better. —> https://amp.cancer.org/support-programs-and-services/patient-lodging/hope-lodge.html
> At treatment, I had PSA of 7.976, localized, Gleason 7(4+3).

Thanks for the clarification. The average SUV in the liver was 4.6. There is no other mention.

About the prostste itself it says:
« No focal abnormal uptake within the prostate. »

I was told, though I amnot sure if I understood this correctly, that the PSMA would also have value as a standard PET CT if there is no PSMA take-up.

If the lack of PSMA uptake would indicate a less-aggressive cancer that would be good news, I guess.

Thanks for describing your case - would you be so kind to tell me how long ago you had Proton therapy and what were side effects (if any). We do not have proton therapy in our area so I am wondering would it be feasible to endure therapy away from home and travel. Also, what was extent of your PC (gleason , localized or not , etc. ) . Thanks so much in advance.

Prostate cancers are very heterogeneous. Just like you can have prostate cancers, one a Gleason 6, one a Gleason 7, and another a Gleason 8, similarly one cancer might express a lot of PSMA, one a little, and another none at all. It’s very heterogeneous,
Normally (but not always) the more aggressive the prostate cancer, the more PSMA expression it has (measured by its SUVmax score). Your Gleason 8 should’ve (but, not always) expressed a lot of PSMA.
Your medical oncologist indicated there was uptake; what was the SUVmax score they assigned to that uptake?
The background, non-cancerous tissues they compare to are the blood, liver, and parotid (salivary) glands that express low, medium, and high levels of PSMA, respectively, without being cancerous . They assign SUVmax values to those (which should be indicated in your PSMA PET scan report); then they compare those scores to the SUVmax scores they’ve assigned to any cancerous lesions that “light up.”