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Just joined this forum. 61 yr old. So many posts. I look forward to diving into them. I had a PSA screen as part of routine exam. 19.2. Scheduled a urology apt. New PSA 18.8. DRE was normal. Biopsy 12 core, nothing notable on ultrasound view. Normal prostate size. Still waiting results. Is it common to be so anxious? I understand from some reports that a normal prostate size and no infection with such a high PSA is or can be indicative of aggressive PC. Worried.
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Hi Michael, Welcome to the site.
Anxiety is pretty much the standard mind set all us prostate cancer guys have in varying levels because even post treatment with a very good prognosis the cancer can return.
Yes, a PSA of 19.2 is concerning, but the many of the most aggressive prostate cancer produces very little PSA. Usually tumor size is what drives the high PSA values.
Nothing happens as quickly as we want in the beginning of the process. When you get a biopsy report things will get much clearer and you will need to evaluate treatment options.
Keep us up to date and we will help all we can.
YOB 1957
DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.
3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
7 Nodes, SV, SM, PNI, and BNI were negative.
LVI and Cribriform pattern present.
Decipher .86 High Risk.
Post Surgery PSA
3/25/19 .03. (25 days)
4/25/19 <.03. (2 months)
5/25/19 <.02 (3 months)
9/10/2019. <.02 (7 months)
11/27/2019. <.02. T < 3 (9 months)
5/19/2020. <.02 (15 months)
11/2/2020. <.02 (21 months)
5/11/2021. <.02 T <3 (27 months)
8/25/2021. <.02 T <3 (30 months)
12/6/2021. <.02 T <3 (33 months)
3 Part Modality Treatment Completed
2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
ADT - 5/19- 5/21 Eligard and Casodex.
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Just heard from urologist. Detected high grade cancer. Know more details next week when we meet. Bone and CT scans ordered. No other data yet. Let the journey begin.Comment
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Just keep in mind a high Gleason score is how the cells appear. Genomics testing tells you the aggressiveness.YOB 1957
DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.
3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
7 Nodes, SV, SM, PNI, and BNI were negative.
LVI and Cribriform pattern present.
Decipher .86 High Risk.
Post Surgery PSA
3/25/19 .03. (25 days)
4/25/19 <.03. (2 months)
5/25/19 <.02 (3 months)
9/10/2019. <.02 (7 months)
11/27/2019. <.02. T < 3 (9 months)
5/19/2020. <.02 (15 months)
11/2/2020. <.02 (21 months)
5/11/2021. <.02 T <3 (27 months)
8/25/2021. <.02 T <3 (30 months)
12/6/2021. <.02 T <3 (33 months)
3 Part Modality Treatment Completed
2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
ADT - 5/19- 5/21 Eligard and Casodex.
Comment
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Hope it goes well. I hate the anxiety. I think it may be worst at the start. We all hope for the best for you. Lots of us get a second read on the biopsy results from Dr. Epstein and John Hopkins.PSA History:
1/22/10 1.7
12/9/11 1.61
2/1/14 1.90
6/5/15 1.57
6/20/16 1.93
1/31/18 1.86
9/16/19 2.33
7/16/21 2.3
7/16/21 2.24
01/10/2022 2.2
Biopsy 9/2021 slides read by local urology group
unfelt small leasion found in 3 sectors
I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
Gle 3+4
Decipher score .26 Low Risk
Johns Hopkins, Dr. Epstein read of slides 10/14/2021
I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
K. Gle 3+3 (group 1), involving 10% of one (1) core
L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core
Henry Ford read of slides:
I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
L. Gleason score 3+4=7 (Group 2), involving
10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%
Multi Parametric MRI 12/10/2021 results:
MPRESSION:
1. No index lesion identified. Patient's known prostate cancer may not be
visualized due to small size and/or low-grade. Overall, MRI findings
compatible with PI RADS 2 abnormality (low likelihood of clinically
significant prostate cancer).
2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
AS for now transpereneal biopsy next fallComment
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Have you chosen a Cancer Center-Of-Excellence? Especially if your PC it is high-grade, you may have several different types of treatments (surgery, radiation, etc) so working out of a "one-stop" location IMO would be best. Good luckBD: 1959 PSA 4.9 11/2012 (no symptoms)
Biopsy 12/2012 Negative
PSA 5.9 05/2013 (still no symptoms)
Biopsy 6/2013 3+4 (thank goodness for PSA tests)
1 core positive (upper left), 1 suspicious (lower left) out of 12
DRE: bump right side T1c; PCA-III = 20 (normala)
Da Vinci 7/18/2013:
Total prostatectomy with seminal vesicles (S13-6085, 1-29, 7/18/13, 29 H&E and 1 paraffin block)
Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
Estimated total volume of carcinoma in entire prostate gland: 10%
TNM: T2b NX MX (Stage IIA)
PSA History:
8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA "undetectable" (PSA <.1)
March '19 = 0.1
April '19 = 0.10 <-- switched to uPSA tests
June '19 = 0.10
Sept '19 = 0.10
Dec '19 = 0.09
Jan '20 = 0.13
May '20 = 0.2 <- standard test by mistake
Jun '20 = 0.11 <- back to uPSA test
Aug '20 = 0.16
Jan '21 = 0.23
Feb '21 =0.20
Mar '21 - started ADT/HT, radiation scheduled
Jun '21 Eight Weeks Radiation @MSKCC
Jul '21 <.05 (T-Level 0)
Feb '22 <.05 (T-Level back to normal)Comment
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Dayglo, haven't chosen anything yet. I have a bone scan and CT scan with contrast Friday. Pending those results, I will try and figure the next best course of action.Comment
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Pathology back. Short answer Gleason 4+3, 4+3, 4+4. Bone and CT scans in a week. Time to saddle up.Comment
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Hi Michael. The lesson we all learn (some sooner than others), is to take one step at a time. Don't assume the worst! The next phase of your workup is to ascertain as best as possible whether the cancer is likely prostate-confined. Start reading up on primary treatments, keeping an open mind. When discussing the surgery option, also ask, based on your upcoming imaging and lesion location, about the likelihood of one or both neurovascular bundles being saved if you opt for a RP. These bundles run along the base (top) of the prostate and control erections.
Djin
69 yr at diagnosis, BPH x 20 yr, 9 (!) negative biopsies, PCA3-
7-05-13 TURP for BPH (90→30 g) path negative for PCa, then 6-mo. checks
6-06-17 Nodule on right + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Nodule was negative for PCa
Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX, G9 (4+5) acinar adenocarcinoma
5% of prostate (4.5 x 5 x 4 cm, 64 g) involved
Dry; ED OK with sildenafil
11-10-17 Decipher score: 0.37, Low Risk:
5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%9-16-17 (5 wk) PSA <0.1
LabCorp uPSA:
11-28-17 (3 m ) 0.010
02-26-18 (6 m ) 0.009
05-30-18 (9 m ) 0.007 (nadir)
08-27-18 (1 yr.) 0.018 (huh?)
09-26-18 (13 m) 0.013 (retest)
11-26-18 (15 m) 0.012
02-25-19 (18 m) 0.015
05-22-19 (21 m) 0.015
08-28-19 (2 yr. ) 0.016
12-18-19 (28 m) 0.015
06-30-20 (34 m) <0.014
12-30-20 (40 m) 0.037 (?)
03-31-21 (43 m) 0.020
07-13-21(46 m) 0.018
01-25-22(52 m) 0.023Comment
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Djin has nailed it per usual. I very much agree with Philtoo about Dr. Epstein at Johns Hopkins. Maybe you're already on that. He's the best there is and changes path reports fairly often - either up or down - but you know you have a definitive answer with him.
DavidBorn 1953. All care at Kaiser in LA.
10/11/18: 2+ low volume (5-20%) G6 cores out of 12. Prostate vol 33g. Confirmed by Dr. Epstein. Ensuing MRIs and bxs similar.
On AS.
Urolift for BPH 10/21/19: no help.
PSA
8/2/18: 1.2
3/26/19: 1.8
6/14/19: 2.2
10/18/19: 2.0
5/2021: 1.6
3/2021: 1.7
10/2021: 1.9
3/2022: 1.9
Head and neck cancer 2009: Surgery and 31 days IMRT. NED for 13 years and counting.Comment
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4+3, 4+3 and 4+4 isn’t great, but if you had a 12 core biopsy and only 25% were positive that’s a good thing.Originally posted by Michael B from Washington View PostLast edited by Duck2; 04-17-2022, 10:40 AM.YOB 1957
DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.
3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
7 Nodes, SV, SM, PNI, and BNI were negative.
LVI and Cribriform pattern present.
Decipher .86 High Risk.
Post Surgery PSA
3/25/19 .03. (25 days)
4/25/19 <.03. (2 months)
5/25/19 <.02 (3 months)
9/10/2019. <.02 (7 months)
11/27/2019. <.02. T < 3 (9 months)
5/19/2020. <.02 (15 months)
11/2/2020. <.02 (21 months)
5/11/2021. <.02 T <3 (27 months)
8/25/2021. <.02 T <3 (30 months)
12/6/2021. <.02 T <3 (33 months)
3 Part Modality Treatment Completed
2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
ADT - 5/19- 5/21 Eligard and Casodex.
Comment
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Also, Can you have them do genetic testing? That will give you some idea of how aggressive it is and help with your evaluation and doesn't take very long for the results.Originally posted by Michael B from Washington View PostPSA History:
1/22/10 1.7
12/9/11 1.61
2/1/14 1.90
6/5/15 1.57
6/20/16 1.93
1/31/18 1.86
9/16/19 2.33
7/16/21 2.3
7/16/21 2.24
01/10/2022 2.2
Biopsy 9/2021 slides read by local urology group
unfelt small leasion found in 3 sectors
I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
Gle 3+4
Decipher score .26 Low Risk
Johns Hopkins, Dr. Epstein read of slides 10/14/2021
I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
K. Gle 3+3 (group 1), involving 10% of one (1) core
L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core
Henry Ford read of slides:
I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
L. Gleason score 3+4=7 (Group 2), involving
10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%
Multi Parametric MRI 12/10/2021 results:
MPRESSION:
1. No index lesion identified. Patient's known prostate cancer may not be
visualized due to small size and/or low-grade. Overall, MRI findings
compatible with PI RADS 2 abnormality (low likelihood of clinically
significant prostate cancer).
2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
AS for now transpereneal biopsy next fallComment
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The one sample that seemed the most concerning was left apex "Gleasons score 4+4, Grade group 4, Gleason pattern 4=100%, Cribiform pattern 4 - present, Quantity: Carcinoma involves 2 of 2 cores, representing approximately 5-10 % of the tissue. Perineural invasion - present.Comment
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Anyone tell me the expectations of my full bone scan and CT with contrast? Any side effects that you experienced and such? Having both same day, this Friday. Seems pretty uneventful except laying still for some time and a not so pleasant drink for the CT. ??? Have a 10K run race following day, wasn't sure if I should cancel or not.Comment
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For the bone scan you drink a tracer, come back a couple hours later and the machine reads the radioactivity coming from you. Afterwards you want to drink lots of water to flush it out. It takes most of your day.
Yes, you can get a genomics test on biopsied tissue, it has more limitations that a test from pathology tissue post surgery because the sample is not as good.
Yes, the 100% core, cribriform and PNI is concerning. If you look at my signature you will see I had a 100% core in the apex and what the pathology was post surgery. Having cores near the base are more concerning than the apex.
You might get a 2nd opinion on the biopsy report from a pathologist at a cancer center of excellence. Jonathan Epstein is one many recommend.
You have <50% chance it is organ contained and two choices for treatment. RT max, which is radioactive seeds with external been radiation and ADT or RP max, which is surgery followed by adjuvant ADT and radiation. Today the RT max seems to be the favored treatment both for cure and less side effects. For either treatment, you don’t want the B team. You want the best radiologist and surgeons you can get for the Brachy (seeds) or surgery, which maybe means road trip. The external beam radiation is not as critical.
Last edited by Duck2; 04-19-2022, 09:06 AM.YOB 1957
DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.
3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
7 Nodes, SV, SM, PNI, and BNI were negative.
LVI and Cribriform pattern present.
Decipher .86 High Risk.
Post Surgery PSA
3/25/19 .03. (25 days)
4/25/19 <.03. (2 months)
5/25/19 <.02 (3 months)
9/10/2019. <.02 (7 months)
11/27/2019. <.02. T < 3 (9 months)
5/19/2020. <.02 (15 months)
11/2/2020. <.02 (21 months)
5/11/2021. <.02 T <3 (27 months)
8/25/2021. <.02 T <3 (30 months)
12/6/2021. <.02 T <3 (33 months)
3 Part Modality Treatment Completed
2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
ADT - 5/19- 5/21 Eligard and Casodex.
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