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Info please. 40 psa - 3+4 gleason

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User
Posted 01 Dec 2024 at 19:02

I have only had my results from a specialist nurse by phone so far , as results only ready Friday and going to Cyprus for two weeks tomorrow, so will not get to speak to consultant until 23 December.  The nurse said it is ok to go. 

I am 72 , and am very fit despite some breathing problems from mild copd- I do a fast 4 mile walk every day and go to gym twice a week.  BMI is 25 but not overweight.

I had no symptoms of any prostate problems , apart from more frequent peeing , but had put that down to age !   The blood test was an annual one to keep an eye on my copd , but as I had never had my psa checked the nurse added it to the checklist.  It came back at 37 , and they did another test - 40.  I am already stressed by now !

I got fast tracked , and the mri gave me 2 fives 2 fours and 2 threes.    Scared to death now !   The nurse said the biopsy was a 3+4 Gleason - with 15 cores out of 30.   They do not thing the cancer has spread to my lymph nodes. She said the ‘committee meeting’ they have has recommended hormone therapy tablets and injections, with 20 sessions of radiotherapy, probably after 3 months.

So , my initial questions I forgot to ask the nurse.

 1. Why so many cores - it seems 12 to 20 is the norm 

2. It seems AS is not an option - is that because of the high core and psa scores ? 

3.  Is it possible to keep my ‘belly’ from expanding from the HT with exercise - I do not want to get fat !

4.  How long do most people have to stay on HT ?

I will probably have other questions but my mind is still trying to process everything !

User
Posted 01 Dec 2024 at 23:34

Originally Posted by: Online Community Member

 1. Why so many cores - it seems 12 to 20 is the norm 

2. It seems AS is not an option - is that because of the high core and psa scores ? 

3.  Is it possible to keep my ‘belly’ from expanding from the HT with exercise - I do not want to get fat !

4.  How long do most people have to stay on HT ?

1. 12 to 20 was the old standard trans rectal biopsy. New biopsies are trans perineal which is safer so more cores can be taken. The more cores taken the better the diagnosis.

2. High PSA, Gleeson above 3+3, large percent of cores. All these factors go against AS.

3. I don't know anyone who lost weight on HT. If you keep active on HT it probably won't go up too drastically. After you stop HT you will probably return to your former weight.

4. Two years would be fairly typical for HT. There is some argument that 18 months is enough. Some people just can't stand it within six months, but I can think of only one person on this site who found it that bad.

Edited by member 01 Dec 2024 at 23:35  | Reason: Not specified

Dave

User
Posted 01 Dec 2024 at 23:40

I agree 30 cores is more than usual, but in reality the more the better if they are looking at random for cancer. However, in your case with the MRI, if they did a fusion MRI directed biopsy they take additional cores from area’s of interest identified as abnormalities from the MRI. Most abnormality lesions are identified using a PIRADS grading system as to their likelihood of containing cancer. You mentioned nothing regarding that from your biopsy but I presume Gleason grades if a 7 (3+4) which is considered a favorable 7. I am not sure what is being referred to as two 5’s, two 4’s and two 6’s. Typically a Gleason 7 favorable versus a Gleason 7 unfavorable (4+3) is still questionable for AS. That is good they don’t believe it has gone to the lymph nodes but is anything mentioned of the prostate capsule appearing breeched also referred to as EPE (Extra Prostatic Extension) or reference to the seminal vesicles or perineural invasion? It seems the nurse may have quickly gone over the pathology report skipping some important points that may be eliminating Surgery as an option for you. I would try yo get her to send or upload a copy of the pathology report and push for a PSMA PET scan.

 
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