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3+4=7 Gleason score July 25
.6 Decipher score July 25
1 PIRAD score July 25
9.36 PSA June 25
I was told I am on the borderline between treatment and more active surveillance. I was told radiation treatment on my 81cc prostate could possibly make urination harder, its not that great now.
Another thing that bothers me is this finding from my 2023 biopsy: "A. Prostate, right base, core biopsy:
- Prostatic adenocarcinoma, Gleason score 3+3=6 (grade group 1) involving 1 of 2 cores (1.5 mm, 10%)
- Perineural invasion is present"
When we discussed the biopsy findings in 2023 he didn't even mention Perineural invasion. Ive since learned that's significant and not good. My latest biopsy did not detect Perineural invasion. But these biopsies are hit and miss.
I got a referral another doctor but I cant see him until October. I'm thinking active surveillance is too risky? It might have already spread outside the prostate. My cancer isn't even visible on the MRI though so some treatments are out. Whats left, radical prostatectomy? I am 68 years old healthy and I have a penile implant so impotence is not a big concern. Incontinence is though.
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Perineural invasion (PNI) is pretty common, it is really not a big factor in your cancer risk. I Noticed a few months ago that my biopsy from 15 years ago had PNI. Found the same thing in a lot of other people’s biopsies, and it was not a factor in their future.
What’s missing in this information is what percentage of that 3+4 had cancer and what percentage of it was a 4? If it comes down to five or 10%, then active surveillance still might make sense.
"Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4=5%), involving 1 of 1 core (5 mm, 30%)"
I read that PNI indicates a pathway for cancer to spread out of the gland.
When we just had the biopsy report more active surveillance seemed like the way to go but then the .6 Decipher score muddied the waters. That indicates I am on the very high end of intermediate risk aka low end of high risk.
The fact that only 5% of your Gleason 3+4 was a pattern 4 is something that usually means you can go on active surveillance.
Yes, PNI can be an issue, but with such a low Gleason score and low pattern 4 percentage it again doesn’t demand immediate treatment. Prostate cancer is very slow growing, You should have plenty of time to make decisions on what treatment you want
It sure would be interesting to know what the PIRAD score Was for the tumor found in your prostate when you had an MRI. Was the PIRAD score a four or five, That shows there’s a possibility you have metastasis.
You shouldn’t need your doctor to give you a referral to get a second opinion. You can just contact a center of excellence or find a GU Oncologist. With your PSA and biopsy information, the doctors would have no problem giving you their thoughts on your treatment.
My PIRAD score was "PI-RADS v2.1 score: 1" Which is exactly the same as it was in 2023. Its weird to me that my biopsies come up with cancer 3 times in a row and the MRI is clear, PIRAD score 1.
Whats your opinion on my .6 Decipher score being in the high risk zone? It even says on the test results print out: "These patients may not be ideal for active surveillance. These patients many benefit from treatment with definitive therapy."
Yes, the .6 is concerning. That’s why I said you should contact a center of excellence or a Genito urinary oncologist. You need some more advice from a doctor. I can’t look at all of your medical results, I can only talk about what is presented. The PIRADS result is just plain confusing. There’s nothing there, But they keep finding something when they do a biopsy.
With your prostate at 81cc You know your PSA is going to be higher than a normal size prostate. Have you had BPH issues, You say it’s hard to pee, Somebody else with BPH reported that going on Antibiotics had enabled them to reduce their PSA and the size of their prostate.
The problem with doing a prostatectomy is that you are worried about spread and if it has spread, they like to do radiation. Of course there is no evidence of spread so a prostatectomy would probably fix your problem peeing, a trade off.
If you’re worried about incontinence after a prostatectomy, it may or may not happen. I had surgery 15 years ago and had to wait two weeks to get the catheter out. I had no problems with incontinence at that time. Some people do have a problem, but most become continent before a year passes.
Yes it is confusing! I was told that since the MRI cant pinpoint the cancer that some possible MRI guided treatments are off the table. Thanks for your help.