1. < Prostate Cancer

Selecting Active Survelliance based on GG1 and small GG2 in biopsy?

Posted by handera @handera, Oct 26, 2023

67 years old, PSA of 7.8 and MPMRI with three PI RADS lesions…one 3, one 4 and one 5. Fusion biopsy of 15 areas indicate 5 Gleason 3+3=6 samples (5-10% of specimen with cancer) and 2 Gleason 3+4=7 samples (with 10-20% of pattern 4 cancer) of the 15 areas sampled. My Urologist (a robotic prostate surgeon) indicates I could choose surgery, radiation or active surveillance (AS) and recommends against surgery, due to my active lifestyle. I routinely run 5K races, at a 9 minute pace, which I did 1 week AFTER my biopsy. I’m considering AS and asking if anyone has had a similar initial biopsy report and can relate their decision, experience and any follow up issues and their routine of the following 12 months..

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rport3 | @rport3 | Nov 3, 2023
In reply to @colleenyoung "@rport3, I’m glad that you remain active and follow a healthy diet with active surveillance. I..." + (show)
@colleenyoung

@rport3, I’m glad that you remain active and follow a healthy diet with active surveillance. I hear you about the “bad news” is that this is not a new lifestyle for you as physical activity and good eating are long engrained habits. While healthy habits reduce the risk of cancer, they don’t guarantee total prevention. I sure wish they did.

Your level of fitness and health will serve you well however should you need treatment in the future. Did you learn anything new with your second opinion?

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I have not yet made it through the scheduling process for the second opinion. I learned that virtual meetings are only available in the mornings which are difficult for me. So, I'm going to ask if I can pay for a virtual appointment in order to have schedule flexibility. But haven't gotten back on it yet. I sent all my records, so hopefully I can get back with scheduling soon. Thanks for your comments.

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ozelli | @ozelli | Dec 8, 2023
In reply to @handera "bens1: Thanks for your comments! I'm just one week into being given the news that I..." + (show)
@handera

bens1: Thanks for your comments! I'm just one week into being given the news that I have prostate cancer, so please understand the following comments in light of my "cancer revelation".

I'm an engineer who spent a 40+ year career in research and development and now I'm one week into researching a subject that is new to me...but I know how to perform research! So far, it seems to me that there is no "standard of care" PC treatment that provides a "cure" without SIGNIFICANT consequences.

Before my fusion biopsy I had absolutely no symptoms (elevated PSA), now I'm sore from having 21 needles poked into my prostate - my only (new) symptoms! From the research papers, books and sources I have read during this short time, it appears that even the best RP treatment will involve at least a week of catheterization, a minimum of 2-3 months of incontinence - possibly lasting as long as 18 months - and an 6-8% change of permanent incontinence...AND a ~70% chance of ED 2 years after RP! All this makes AS (at my stage, having no symptoms other than a sore prostate due to a biopsy) sounds quite appealing!

I'm exploring radiation treatments, but I having difficulty getting over "the idea of poisoning my way back to health" (as one source put it). In any case, I appreciate your comments and that you are happy with your treatment decision. I'll probably be further down the road of "acceptance" of this diagnosis after I've had more time to absorb its impact and I'm further down the road regarding my own research.

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Who told you "the idea of poisoning my way back to health"? What does this mean to you?

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handera | @handera | Dec 8, 2023

Didn’t hear it, read it, in the second book I purchased about cancer.

My first purchase, after getting my mpMRI results was “ Dr. Patrick Walsh's Guide to Surviving Prostate Cancer” (latest 5th edition).

After I read that book, cover to cover, I learned about and read “Chris Beats Cancer” by Chris Wark.

Wark has a captivating “tongue-in-cheek” style of writing that I find absolutely hilarious…exactly what I needed in the first few weeks after learning I had a PCa diagnosis.

Wark writes in the first chapter of his book “The more I thought about chemotherapy, the less I wanted to do it. The idea of poisoning my way back to health didn’t make sense to me, but I was deeply conflicted.”

My reference of Wark’s comment in my post was slightly out of context, but you get the point.

Aspects of Wark’s “comprehensive plan for heally naturally” are too radical for me; but he certainly got me thinking and I’m better off for reading his book.

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keywest19 | @keywest19 | Dec 8, 2023
In reply to @handera "bens1: Thanks for your comments! I'm just one week into being given the news that I..." + (show)
@handera

bens1: Thanks for your comments! I'm just one week into being given the news that I have prostate cancer, so please understand the following comments in light of my "cancer revelation".

I'm an engineer who spent a 40+ year career in research and development and now I'm one week into researching a subject that is new to me...but I know how to perform research! So far, it seems to me that there is no "standard of care" PC treatment that provides a "cure" without SIGNIFICANT consequences.

Before my fusion biopsy I had absolutely no symptoms (elevated PSA), now I'm sore from having 21 needles poked into my prostate - my only (new) symptoms! From the research papers, books and sources I have read during this short time, it appears that even the best RP treatment will involve at least a week of catheterization, a minimum of 2-3 months of incontinence - possibly lasting as long as 18 months - and an 6-8% change of permanent incontinence...AND a ~70% chance of ED 2 years after RP! All this makes AS (at my stage, having no symptoms other than a sore prostate due to a biopsy) sounds quite appealing!

I'm exploring radiation treatments, but I having difficulty getting over "the idea of poisoning my way back to health" (as one source put it). In any case, I appreciate your comments and that you are happy with your treatment decision. I'll probably be further down the road of "acceptance" of this diagnosis after I've had more time to absorb its impact and I'm further down the road regarding my own research.

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I had a TRUS biopsy and the results came back 3+4. Wish I could have had a MRI fusion biopsy like you. I then sent the samples for Prolaris testing. It came back I was on the borderline for active surveillance/treat. I decided to have my prostate removed at Mayo. Post surgery pathology came back upgraded at 4+3. Seems the biopsy missed significant cancer. I'm glad I had it removed. Catheter kinda sucked but it was only for seven days. I had 0 issues with incontinence, 0 leaks. I was very pleased. Still have some ed but i'm only 3 months out. I refrained from lifting anything over 10 lbs for six weeks but have no limitations now. I'm 59 by the way. Tuesday I go for my first PSA post surgery. It's a tough decision about how to proceed and I can tell you I prayed quite a bit and asked for guidance. Never thought Mayo was an option due to being out of state but low and behold, I was moved to make the call, and they accepted my insurance. Best wishes on whatever path you choose. I hope all goes well!

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1 reply
handera | @handera | Dec 8, 2023
In reply to @keywest19 "I had a TRUS biopsy and the results came back 3+4. Wish I could have had..." + (show)
@keywest19

I had a TRUS biopsy and the results came back 3+4. Wish I could have had a MRI fusion biopsy like you. I then sent the samples for Prolaris testing. It came back I was on the borderline for active surveillance/treat. I decided to have my prostate removed at Mayo. Post surgery pathology came back upgraded at 4+3. Seems the biopsy missed significant cancer. I'm glad I had it removed. Catheter kinda sucked but it was only for seven days. I had 0 issues with incontinence, 0 leaks. I was very pleased. Still have some ed but i'm only 3 months out. I refrained from lifting anything over 10 lbs for six weeks but have no limitations now. I'm 59 by the way. Tuesday I go for my first PSA post surgery. It's a tough decision about how to proceed and I can tell you I prayed quite a bit and asked for guidance. Never thought Mayo was an option due to being out of state but low and behold, I was moved to make the call, and they accepted my insurance. Best wishes on whatever path you choose. I hope all goes well!

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Thanks for your comments!

In my case, three lesions were found (3, 4 and 5 PIRADS) in the mpMRI.

The fusion targeted portion of my biopsy found 3 + 3 Gleason in the 4 and 5 PIRADS lesions and benign tissue in the PIRADS 3 lesion.

If it hadn’t of been for the random 12 core biopsy, performed at the same time, my two 3 + 4 cores would not have been found.

Even so, both 3+4 cores were found with only 20% fused cell 4 type (no cribriform or intraductal carcinoma). Maybe that’s why (being too small) they weren’t able to be detected in my particular mpMRI scan…I don’t know.

I’m awaiting a 2nd opinion of my biopsy report.

The point is that mpMRI can over diagnose and (apparently) miss very small, possibly more significant lesions.

In fact, mpMRI over diagnosis of PIRADS 5 lesions is quite common, even at the “best” prostate specific mpMRI reading laboratories (see my 2nd question thread for details about this issue).

It’s good to hear you are pleased with the results of your RP.

All the best to you for a PCa free future!

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