Dx with GS8 and thinking of Brachytherapy without HT

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MacroMan
Regular Member


Date Joined Aug 2017
Total Posts : 29
   Posted 11/8/2017 5:44 PM (GMT -7)   
I've just had my first visit with an RO.

I have only one 10mm core of 13 that shows cancer GS8 (4+4) 40%. That works out to only 4mm of Gleason Grade 4 cancer and this is from a fusion biopsy. One other core was PIN (close to the cancerous core) and all the other cores were benign prostatic tissue.

The RO doctor is willing to do brachytherapy with no HT because the volume of Gleason Grade 4 is small.

Others on this forum may be more fortunate having GS7 (4+3) or even (3+4) but with more than half the biopsies positive. So, if their total volume of GG4 is more than 4mm how would I be worse off?
DOB: Oct 1955
Greater Vancouver

PSA 4.4 May'16
5.79 Oct'16
5.0 Jan '17
7.1 Apr'17
6.1 Sept'17

MRI Jun'17
Prostate Biopsy late Sept'17
Prostate Size 36cc

Dx Oct. 16, 2017
1 core (Right Side -Mid medial) of 13 showed cancer (adenocarcinoma) GS 8 4+4 40%
PIN - High Grade 1 core (Right Side - Base Lateral)
Low Tier - High Risk

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2510
   Posted 11/8/2017 6:31 PM (GMT -7)   
I do not know the answer to your question, but did you get a second opinion on your biopsy slides? If it were me, I'd want some validation on the amount of #4 cells as part of my decision making. Perhaps also worth talking to more than RO to get their opinion.

What kind of brachy are you considering? LDR or HDR?
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

MacroMan
Regular Member


Date Joined Aug 2017
Total Posts : 29
   Posted 11/8/2017 6:35 PM (GMT -7)   
It would be LDR.

The urologist suggested a second opinion was unnecessary because the team reviewing my biopsy was very experienced.
DOB: Oct 1955
Greater Vancouver

PSA 4.4 May'16
5.79 Oct'16
5.0 Jan '17
7.1 Apr'17
6.1 Sept'17

MRI Jun'17
Prostate Biopsy late Sept'17
Prostate Size 36cc

Dx Oct. 16, 2017
1 core (Right Side -Mid medial) of 13 showed cancer (adenocarcinoma) GS 8 4+4 40%
PIN - High Grade 1 core (Right Side - Base Lateral)
Low Tier - High Risk

GeetarMan
Regular Member


Date Joined Mar 2014
Total Posts : 258
   Posted 11/8/2017 6:44 PM (GMT -7)   
MacroMan said...
The urologist suggested a second opinion was unnecessary because the team reviewing my biopsy was very experienced.


Oh my. This would be a red flag to me. Absolutely get a second opinion from Bostwick or Johns Hopkins.
DOB 9/14/58 - Age 58
Yearly PSA History:
.58, .60, 1.11, 1.00, 1.74, 2.85 (01/2014)
3 Month AS PSA History:
.7 (04/30/14), .54, .85, .64, .74, .85, .68, .70, .99, 1.04, 1.24, 1.12, 1.15 (07/31/17)
DRE Normal
2/19/14 Biopsy:
G6 Adenocarcenoma
<5% - 1 out of 10 samples
Prostate 31g

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2510
   Posted 11/8/2017 6:53 PM (GMT -7)   
My urologist told me exactly the same thing. But I sent it to Epstein at Johns Hopkins and was upgraded from a Gleason 8 to a Gleason 9. (Not saying that would happen to you, of course. You could be downgraded. Or not change at all.) It's quick and easy to do this and insurance generally pays for it. (Meaning that they see a value in doing this.)

Keep in mind that pathologists at hospitals read all sorts of biopsy slides. Epstein's lab reads just one thing: prostate cancer slides. It's the difference between taking your Mercedes to a shop that serves all cars and taking it to a shop that just works on Mercedes. My two cents.
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

Dogdays
Regular Member


Date Joined Jan 2017
Total Posts : 113
   Posted 11/9/2017 4:38 AM (GMT -7)   
^^^^THIS^^^^
If your doctor is telling you that you don't need a second opinion, first thing I'd do is get a second opinion. Nothing to lose but plenty to gain.
Age at Dx. 63
PSA 1/08 1.4, 12/16 12.17, 4/17 3.8, 7/17 1.05, 10/17 <.05 (HT)
GS 9 (4+5)
CT Scan and bone scan 1/17 both negative
2/2/17 prostate MRI.
2/27/17 pelvic bone biopsy done. No mets
3/7/17 Started HT. Degarelix, 4/17 lupron (1-2 years)
7/7/17 Brachy (Zelefsky MSK)
8/25/17 SHARP (SBRT) finished at MSK

MacroMan
Regular Member


Date Joined Aug 2017
Total Posts : 29
   Posted 11/9/2017 7:05 AM (GMT -7)   
Let's try this again.

I've just had my first visit with an RO.

I have only one 10mm core of 13 that shows cancer GS8 (4+4) 40%. That works out to only 4mm of Gleason Grade 4 cancer and this is from a fusion biopsy. One other core was PIN (close to the cancerous core) and all the other cores were benign prostatic tissue.

The RO doctor is willing to do brachytherapy with no HT because the volume of Gleason Grade 4 is small.

Others on this forum may be more fortunate having GS7 (4+3) or even (3+4) but with more than half the biopsies positive. So, if their total volume of GG4 is more than 4mm how would I be worse off?
DOB: Oct 1955
Greater Vancouver

PSA 4.4 May'16
5.79 Oct'16
5.0 Jan '17
7.1 Apr'17
6.1 Sept'17

MRI Jun'17
Prostate Biopsy late Sept'17
Prostate Size 36cc

Dx Oct. 16, 2017
1 core (Right Side -Mid medial) of 13 showed cancer (adenocarcinoma) GS 8 4+4 40%
PIN - High Grade 1 core (Right Side - Base Lateral)
Low Tier - High Risk

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3388
   Posted 11/9/2017 7:56 AM (GMT -7)   
Yes, let's try this again. It is extremely prudent to get the slides read by either Bostwick or Epstein. They are the prostate cancer specialists in North America. If you want an European to read them send them to Bonkhopf in Germany.

No offense to your current team, but it is absolutely routine to get a second opinion on the slides from the true specialists. Since when did more information hurt anything? And if the second read confirms the first then your confidence level increases. Also a great outcome.

As to ADT, of course I would use it.......especially in your high risk situation. It simply enables the radiation to be more effective. You would only be on for 4-6 months and would have little in the way of side effects for a short period of time.

Don't be frivolous about one small bit of G4. You have no idea how much G4 there is, or where it might be, or whether there is any G5. The biopsy sampled only about one tenth of one percent of the prostate and missed several areas entirely.

You are high risk and should hit this with a mighty strong hammer. Better to get it all now than have to hit it again and again in the future.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

MacroMan
Regular Member


Date Joined Aug 2017
Total Posts : 29
   Posted 11/9/2017 10:26 AM (GMT -7)   
A second opinion has been initiated.
DOB: Oct 1955
Greater Vancouver

PSA 4.4 May'16
5.79 Oct'16
5.0 Jan '17
7.1 Apr'17
6.1 Sept'17

MRI Jun'17
Prostate Biopsy late Sept'17
Prostate Size 36cc

Dx Oct. 16, 2017
1 core (Right Side -Mid medial) of 13 showed cancer (adenocarcinoma) GS 8 4+4 40%
PIN - High Grade 1 core (Right Side - Base Lateral)
Low Tier - High Risk

lapilot
Veteran Member


Date Joined Nov 2012
Total Posts : 811
   Posted 11/11/2017 6:30 AM (GMT -7)   
Definitely you should get a second opinion on the pathology. There is always the possibility that it would be upgraded or downgrade. Additionally, you can have a tertiary 5 lurking in the path specimen. At GS8 (4+4) you sit at a point where therapies can make a big outcome. If it is downgraded then HT usually isn't required, but at GS8 and above HT with radiation is usually the standard treatment.
Age 60, mpMRI 8/18/13 negative
biopsy 9/5/13, PSA 6.2, 13 core of which 6 are postive
pT2pNO
left laterial base 10% G6(3+3)
left laterial apex 10% G6(3+3)
right base 15% G7(3+4)
right laterial base 15% G6(3+3)
right laterial mid 60% G6(3+3)
right lateral apex 20% G6(3+3)
daVinci 11/11/13
path T2c N0 Stage IIB
PSA 0.1 to 11/15 then 0.2
11/15 IGRT 39 sessions 72 grays. ZERO problems.
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