Hi M1, I would get more expert opinions if your are serious about
AS, but I believe you are a poor AS candidate for these reasons:
1. Most published AS protocols at major institutions that allow G7 (3+4)
allow just one
low-volume core -- you had three such cores in three different zones, one with a high percentage tumor (60%) to boot!
2. Perineural invasion
(PNI) found at the time of biopsy is correlated by many -- but not all -- researchers with a higher risk of adverse findings being present, as confirmed in those men who go on to RP and have their entire prostates examined. (As many as 80% of men who do surgery have a finding of PNI somewhere in their prostates; however seeing it at the time of biopsy, when only a tiny amount of tissue is sampled, is taken as a sign that it has been there longer and is more extensive.)
3. The presence of cribriform pattern 4
is another finding associated with a poorer prognosis and even alone may be reason to rule out AS and seek treatment.Prostate cancer with cribriform pattern: Exclusion criterion for active surveillance?
"Following the 2014 International Society of Urological Pathology meeting, a rapidly growing body of evidence by several researchers has been demonstrating a poor prognosis in association with cribriform morphology"Update and optimization of active surveillance in prostate cancer in 2021
"The pathologist must identify the cribriform or intraductal histology on biopsies in order to exclude these patients from AS, in the same way as with patients with alterations in DNA repair genes."
4. Regarding metastatic potential
, it's encouraging that your Oncotype genomic test came back low risk. However, (a) prostate cancer can advance locally with non-metastatic growth into adjacent tissues, and (b) genomic tests done on biopsied tissue can miss lesions with a higher metastatic potential (just as they can miss lesions with a higher Gleason score than any found). Or, even if your biopsy did capture a "worst-case" lesion, the genomic test may not have sampled it. In fact, the Decipher Prostate test (a competitor of Oncotype) clearly states on its reports that results done on biopsy tissue correlate with the same person's results done on post-RP tissue 70% of the time, which means, of course, that 30% of the time it doesn't (the reason again being either that the biopsy missed a lesions with a higher met risk or that neither of the two different tissue samples Decipher tests captured the worst case lesion).
I'm only suggesting you do due diligence and research these topics with regard to AS and your diagnostic workup results before making a decision. If you do begin AS, be sure to have your confirmatory biopsy within a year
, as the best AS programs advise.
Did you get a second opinion on your biopsy pathology? Have any of your docs told you that you are an AS candidate?