New Biopsy Results

User

Posted 17 Feb 2024 at 03:37

Hi Everyone, new to the group. Age 70. PSA level 1.9 for years, started bouncing within last 18 month period up to 3 down to 2.4 up to 4.0 down to 3.5 up to 4.0 down to 3.3. MpMRI identified lesion .9x.5x.9. cm. Urologist did fusion ultrasound biopsy and took 3 cores from lesion, that showed Benign prostatic glands and stroma, however one core same side came back Gleason 7 (3+4) and one core Gleason 6 (3+3). What surprised him was opposite side with one core coming back Gleason 8 (4+4). He did say that the core showed only 8% of tissue involved. Pathology report states 18 cores, however Dr.’s after summary says he took 15 cores. (I thought he told me 12 and I thought I felt only 12) regardless he told me he placed the 3 cores from the lesion in one cyclinder and made no other mention of placing other multiple cores in the same cylinder. The Pathology reports shows Left Base (2cores) Left Mid Lateral (2cores) and Left Apex (2cores) and the 3 cores of the lesion mentioned Left Peripheral Zone (3cores). All other 9 areas mention 1 core. The Pathology Summary states 12 Sites Prostate Biopsy, 13 Sites Specimen. The numbers don’t add to me am I missing something. I thought a biopsy site was one core. Any input appreciated,

Ned

User

Posted 17 Feb 2024 at 09:16

Hi Ned,

I'm sorry that you've had to find us but glad you have. They're are a lot of knowledgeable people on here, but unfortunately I'm not one of them and just wanted to bump your question.

Apparently most elderly males have cancers in their prostate. On both my biopsy reports the number of cores were all accounted for. The discrepancy in the amount of cores taken seems weird. I know I once used a Predict NHS tool to try a decipher my biopsy results and I'm pretty sure they mentioned, for their purposes cores taken in the targeted area, the lesion, were only counted as one?

Anyway mate, I'm sure someone will be along soon and they'll be much more helpful.

User

Posted 17 Feb 2024 at 14:22

Thanks Adrian!

My U doubts spreading but has wants PET done. He is gone for week so I can’t question him about report. If just one core is 8 (4+4) and only 8 percent tissue involvement that amount of tissue involvement seems low. Also I read some study that many 8’s (4+4 ) upon RP were downgraded to 7’s.

User

Posted 17 Feb 2024 at 15:28

I forgot to ask you Ned. Have you been given a cancer staging? What treatment, if any, is being considered?

User

Posted 17 Feb 2024 at 16:52

My Urologist replied to my message regarding the number of cores and he said that when the Pathology lab receives the cores, some may not have been as strong and broken where you have two pieces and then the lab will mark it as two cores, but it was just one core. The only staging I have been given in the individual biopsy Gleason scores as follows

Left Base Lateral-Prostatic Adenocarcinoma (PA), Gleason score (GS) 3+3=6; 1.00 mm; 9% of tissue Group 1

Left Base-PA; GS 3+4(5%)=7; 1.50mm; 8% of tissue Group 2

Right Base Lateral-PA; GS 4+4=8; 1.00mm; 8% of tissue Group 4

Left Mid Lateral-PA;GS 3+3=6;0.50mm;4% of tissue Group 1 High-grade prostatic intraepithelial neoplasia.

Left Mid -Small focus of atypical glands, suspicious for adencarcinoma

Right Apex Lateral-PA; GS 3+4(19%)=7; 3.00mm; 25% of tissue Group 2

and then the .9x.5x.9 lesion identified on the MRI which prompted the Biopsy was identified Left Peripheral Zone as Benign prostatic glands and stroma

The MRI did not even identify other areas so what worried me (lesion) turned out nothing but opened all these other things.

A question I have on the GS 8 is a 8% of tissue considered in any way. Does it mean it’s only insignificant at the moment and how quickly does it become a larger part of the tissue?

On Monday calling to try and get PET scheduled, follow up appt with Urologist March 6 to then go over PET results. He is also ordering a Decipher Genomic test of biopsy.

Thanks

Ned

User

Posted 18 Feb 2024 at 20:40

Hi,

My biopsy found a small amount 5% on one pin, said to be Gleason 4+3. 12 pins were taken but only 9 had samples. From that I had an MRI that said I'd a 13mm lesion and the post surgery pathology confirmed 4+4. It was quite good fortune it was found when it was with just 5% on one pin.

Your lesion at .9x.5x.9. cm is about 9mm. That and Gleason 3+4 usually determines how fast treatment is needed. Also you might consider where it's located. If it's near an edge you might want treatment quicker or if there is more than one lesion.

If it was me I'd be considering what options there are likely to be and what I'd prefer. My Macmillan Nurse had tipped me off on what was likely to happen and I'd already decided surgery when I saw the consultant and he rang the surgeon right away. If I'd asked for time to think it would have delayed my op over Christmas adding another month. Although for you Christmas isn't an issue but delay can create more delay.

Surgery may not be the only option and probably won't be. So good luck.

Regards
Peter

User

Posted 20 Feb 2024 at 16:10

Thanks Peter,

Things are still spinning for me. I actually am thinking surgery, but with I think several months to go through more tests, 2nd opinions, it could be fall. Certainly before Christmas

User

Posted 28 Feb 2024 at 15:11

Hi Ned

its a surreal rollercoaster of a journey.

personally I’d try not to delay any treatment when predominantly type 4 cancer cells have been found in biopsy samples.

prostate cancer tends to be multifocal plus it has a habit of appearing in anterior areas apparently.

in my case on biopsy all four quadrants of the prostate has evidence of tumour. Initial staging with stage 1. But my prof said with cancer that in multiple areas it’s about ~45% likely to be upgraded on post RARP histology. In my case about 60%. As it turned out my speed to get treatment paid dividends as the cancer was more advanced than had been shown on a 3T mpMRI. It was close to breaking out of the prostate but thankfully hadn’t so my final grading was T2c.

if you go down the surgical path look for a high volume surgeon ( greater than 100 ops per year) with good stats and try and get it done with neuroSAFE if possible for real time visibility during surgery.

i don’t want to cause you unnecessary worry but it’s best not to delay too much if it can be avoided. I was tempted to wait a few months until after Xmas (Q4 2019) but so thankful I didn’t as I would have been likely gone to T3 plus would have hit the Covid pandemic lockdowns potentially head on.

User

Posted 28 Feb 2024 at 16:27

Thank you for your input. It is such a roller coaster. The more I research the more dizzying it gets. I just came across a NIH study of false negatives from MpMRI. My scan showed nothing but the lesion scored as PiRADS 4. If that lesion had not been there it would have been a PiRADS 2, and I would have not gone on to any biopsy, however since the (false positive )forced the biopsy decision the biopsy identified the two 3+4’s, two 3+3’s and the outlier one 4+4, but only 8% involvement. In loooking at false negative studies since the accuracy I knew was fairly high with MpMRI, the study I found of MpMRI scans reevaluated after RP listed 68 out of 3,105 sectors with false negatives . What is significant about this study it related 63% missed it turned out were 3+4, 17% were 3+3, and 25% were 4+3. It states zero percent missed in 4+4. That in addition to another study that after RP 60% of 4+4 were downgraded to a Gleason 7 if biopsy was only one 4+4, less than 50percent involvement and other cores contained a 3. I still need to review with my Doctor but it really seems I am a Gleason 7, not an 8. That certainly does not change that I need to focus on selection of a treatment but going from advanced category in my mind to intermediate I feels gives me a little more time, especially in light of the study that says six months from a DX to treatment was determined no effect on the persons outcome.
NED

User

Posted 28 Feb 2024 at 20:02

Hope it helps. There is a saying amongst radiologists that if you want 50 different interpretations of a scan ask 50 radiologists. UCLH in London have some of the best leading and respected radiologists in terms of prostate scan interpretations.

I was pirads 4 too. Some scanners are better than others I’ve noticed. Some are quite old and really should be EOL but I guess budgets don’t allow this.

best of luck with getting a treatment plan to move things forward. My biopsy (Gleason 6) was carried out September 2019…surgery 2019. The surgeon said he had to take more tissue around the bladder neck due to it more extensive than the scan/biopsy had shown. And it was perhaps a month or so from breaking out. 😵‍💫 Final histology Gleason 7 (3+4) T2c

keep us posted with your journey.

cheers

simon

Edited by member 28 Feb 2024 at 20:08 | Reason: Not specified

User

Posted 28 Feb 2024 at 21:05

Ned, good luck. In some ways the stage where you are wondering what treatment to accept is the most stressful of the entire process. Like you I got a bit obsessed trying to make sense of the academic papers - but in the end what they say is that there isn't any big difference between approaches and it is up to you to decide what your body can tolerate best in terms of the immediate impacts of treatments and the longer term side effects.

I do get the impression that it would be unwise to lean too heavily on the imaging results, while a strong signal is important a weak or undetectable signal doesn't reliably indicate an absence of cancer. Biopsies are better - but of course the cores taken are only a minority sample and no one knows whether the rest of the prostate has a similar distribution of pathologies.

The good thing is that the PSA values you report don't suggest fast growth. You have a bit of time to wait for further results and make your decision, but don't wait too long.

User

Posted 29 Feb 2024 at 01:10

J-B,

Thank you for sharing your thoughts. You are so right about the papers, and imaging. I know that I will ultimately need to make a decision about moving forward but do feel under less pressure and feel I have time for seeking 2nd opinions once all the additional results come in( PMSA PET, Decipher genomic evaluation) even if that takes several months. My mpMRI was in mid Jan, biopsy early Feb, PET scheduled early March, genomic results end of March early April. It seems just gathering what is needed to make the decision take months, that’s why I am taking the NIH studies to make my glass half full, not half empty. I really feel at 70, turning 71 with the average life expectancy in the US for male around 76, I imagine I could just ignore everything anyway (which I won’t). Will keep you up to date.

NED

User

Posted 29 Feb 2024 at 01:18

Simon,

Thanks for replying. This is such a hard decision, but 21 years ago I went through non-Hodgkins lymphoma, went into a clinical trial and beat it. I spent a lot of time researching treatments and really learned how oncologist’s can all give different recommendations for the same thing. I know if I had taken other recommendations I would not be in the 20 year remission. I also spent a lot of time absorbing the wealth of information from support groups such as this listening to what other people are doing and how they made their decisions.

NED

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