Diagnosed today with prostate cancer

Diseases & Conditions Prostate Cancer
1

Hello Warriors,

My name is Joe and I am the baby brother of Bud AKA RADDAD who was very active in this forum in the early 2010’s. I vividly remember how Bud spoke about this forum and his love for all of you. Firstly, I am the better looking brother although he had much more hair. HAHA. Sorry, but as a family we always joked.

Today, like so many men, I was diagnosed with prostate cancer and will be meeting with doctors at Sloan on Thursday to decide if total prostatectomy or radiation is in my future.

Can you tell me about your journey with either or both please?

And I think a signature is required and promise to only summarize in future.;

March 2026 Checkup showed PSA 3.74 to 6.04 in one year. A 60% increase.

Biopsy on 8/17 after MRI findings.

Prostate, right medial apex; biopsy:

Prostatic adenocarcinoma, Grade group 1 (Gleason score 3+3=6), involving 1 of 1 core

Percentage of tissue with carcinoma: 3%

Prostate, left medial apex; biopsy:

Prostatic adenocarcinoma, Grade group 2 (Gleason score 3+4=7) [20% pattern 4], involving 1 of 1 core

Prostate, left medial base; biopsy:

Prostatic adenocarcinoma, Grade group 1 (Gleason score 3+3=6), involving 1 of 1 core

Percentage of tissue with carcinoma: 30%

Linear amount of tissue with carcinoma: 3.5 mm

Perineural invasion is identified

Prostate, left lateral apex; biopsy:

Prostatic adenocarcinoma, Grade group 1 (Gleason score 3+3=6), involving 1 of 1 core

Percentage of tissue with carcinoma: 5%

Linear amount of tissue with carcinoma: 0.8 mm

Cribriform glands: not identified

Percentage of tissue with carcinoma: 50%

Linear amount of tissue with carcinoma: 5.5 mm

Prostate, right transition zone; biopsy:

Prostatic adenocarcinoma, Grade group 1 (Gleason score 3+3=6), involving 1 of 1 core

Percentage of tissue with carcinoma: 20%

Linear amount of tissue with carcinoma: 2 mm

High grade prostatic intraepithelial neoplasia (HGPIN) is identified

PIN-4 immunohistochemical stain is negative for basal cell markers and positive for AMACR/racemase in the atypical focus, supporting the diagnosis

prostate target lesion, right, anterior, base to mid-gland, peripheral and transition zone; biopsy:

Prostatic adenocarcinoma, Grade group 1 (Gleason score 3+3=6), involving 2 of 4 cores

Percentage of tissue with carcinoma: 40%

Linear amount of tissue with carcinoma: 16 mm

Prostate target lesion, left, posterior, mid-gland, peripheral zone; biopsy:

Prostatic adenocarcinoma, Grade group 2 (Gleason score 3+4=7) [30% pattern 4], involving 2 of 2 cores

Cribriform glands: not identified

Percentage of tissue with carcinoma: 40%

Linear amount of tissue with carcinoma: 8.5 mm

Perineural invasion is identified

Prostate target lesion, left, anterior, mid-gland to apex, transition zone; biopsy:

Prostatic adenocarcinoma, Grade group 1 (Gleason score 3+3=6), involving 1 of 2 cores

Percentage of tissue with carcinoma: 30%

Linear amount of tissue with carcinoma: 8 mm

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Let me startby welcoming you to the group. You have made an excellent choice to tap the knowledge of your brothers in the PCa treatment. Just about all of us here have been where you are now. When I first came here, I was advised by several of the members to get a second opinion of my diagnosis by sending my samples to John Hopkins. I took their advice and did go for the second opinion at JH and was upgraded in my diagnosis. If I hadn’t taken the advice of my brothers here, I would probably have been undertreated and most likely be running into more challenges with PCa in the future. If you choose to go for the advice of the gentlemen here and find no change in diagnosis, you have lost nothing. But, if there is an upgrade in diagnosis, then you will treat your PCa more aggressively. I wish you well in your future treatment and will be looking forward to hearing that your treatment went well and you are getting “0s” on future PSA follow-up tests.

Listen to the men here and standby whatever treatment decision you make.

Ron aka: Boomer

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Thanks Boomer. I definitely value the opinions of all brothers here. My journey tonite was to ask the wife to open the “good wine”. HA.

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:grin: I guess that’s one way to begin your journey.

Ron aka: Boomer

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Hi Joe, and Welcome to the club we’re all trying to get out of :wink: I’m a firm believer in trying to get as much information as possible about one’s specific cancer. I’d ask your uro if he/she has had experience with the relatively new ArteraAI (prostate) genomic test. Men with any Gleason score (or grade group) can have cancers that vary in aggressiveness – basically their likelihood of progressing and metastasizing; that’s the value of the newer tests.

These genomic tests also quantify the likelihood of your cancer currently harboring lesions with a higher Gleason score that were missed on biopsy. These are the roughly 30% of men who – if they choose surgery – are upgraded to a higher Gleason score when their whole prostate is removed and examined. I should mention that perineural invasion (PNI) when seen at biopsy is a hint that your risk of having higher-grade lesions or spread out of the thin prostate capsule is actually greater than 1/3; however, ask your uro’s opinion about its significance.

We’re here to try to answer your questions, point you to sources of information that may be of help, and offer our experience and support. Two men with identical PCa statuses may choose different treatment modalities for various reasons, each making the correct choice! It will be your informed choice in the end. I’ll say only that IF you should choose surgery, the choice of a surgeon (and their team and institution) is the most important factor in stacking the cards in favor of an excellent outcome.

BTW, you can leave the “HGPIN” out of your signature – cells that may be cancer precursors are small potatoes for us guys who have already made it to the big league.

Djin

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Welcome Joe.

A couple of questions to kick this off if you don’t mind.

How old are you?

What is status of your brother? Other men in family?

You list 8 cores with cancer. Were there more that were benign?

As Djin noted, there are some better blood rests and there is also genomic testing of the cancer samples now as well as PSMA PET scans that can look for spread from the prostate if warranted. It is a new world compared to just a few years ago.

That being said, PCa is still not a good time for any man and treatments generally suck with no warranty.

You sound like you have a pretty good handle on the situation so ask questions when they come up.

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Hey Mumbo,

Yes Djin info was extremely informative so thank you Djin.

I am 67 and both brothers have passed with RADDAD, the oldest, passing in 2013 after a valiant effort in fighting “this crap” as he called it. The middle brother passed 5 years ago from a heart attack but had throat, lung and eventually prostate cancer that he was “cured” of.

That history is particularly disconcerting for me but it is very likely they were both exposed to Agent Orange.

The doctor mentioned that these are “not a high risk” and “no hallmarks of aggressiveness” and no other cores were benign. However, at this point and in consideration of my family history, I am considering removal over radiation but will decide soon.

Thanks Mumbo and best of health to you.

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UPDATE: I commented here that the decision to have prostatectomy is an easy one. Your opinion on that comment please .

“the club we’re all trying to get out of”.. ain’t that the truth.

Thanks for the additional info re: PNI and that coupled with the percentage of tissue with carcinoma and linear amount of tissue with it may make my decision an easy one and that is prostatectomy. The darn side effects of either choice are not optimal.

Great info on ArteraAI.

RAD_DAD_Baby_bro

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It’s fine to have a tentative treatment plan (subject to change) in mind, but I would wait until your diagnositic workup is complete and (unless you rule out RT for personal reasons) meet with an R.O. I prefer not to “lobby” on the RP vs RT question in cases where the professionals offer both paths as reasonable choices. I’m sure other Forum members will offer their experiences & opinions.

Djin

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You might add genetic consult and testing to your list. My Dad had PC but I was looking out for brother and 2 sons more than me. It is also good to know if there is anything lurking that could increase risk or benefit future treatments.

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I agree with Djin, do your research first and meet with as many doctors as needed to make informed decision. Surgery is simpler to understand, find a good surgeon with a lot of experience and ask lots of questions.

RT is more complex as there are multiple treatment schemes including hormone therapy so you may want to visit with a couple of RO’s that specialize or favor specific treatment types. Once you start narrowing it down, then your questions will be more focused.

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Hello Joe and welcome. Sorry you have to be here but we are glad to help and support you. I remember Bud well. He was a frequent poster and quite a supportive friend to many other members. We all felt his loss. And, I think I recall that your other brother posted here at least for a short time. I recall (???) that he chose Active Surveillance over treatment - my condolences on his passing as well.

I’ll second a couple of the suggestions so far. Getting a second reading on your pathology slides is wise - you want to make sure of the pathology before you make a treatment choice. And, Genomic testing has come a long way and can help you finalize your decisions.

I understand and appreciate the “get it out” bias; I initially had it as well but ultimately opted for a “get it cured” mentality as I considered the treatments options. Ultimately I chose LDR Brachytherapy and am now 18 years cured with zero urinary or sexual side effects. My advice is like Djin’s - it’s ok to have some bias going in but please, please, please, try to have an open mind and make an educated choice. With your stats any of the mainstream radiation treatments should work as well as surgery and I urge you to examine those as well as talking with a surgeon. SBRT and HDR Brachy would both seem to be reasonable options for you to consider and Sloan offers both. Over the years, our most dissatisfied members seem to be those who rushed into treatment w/o considering all of the options. Conversely, those who DID consider multiple options and made an educated decision seem to be more at peace with what they chose.

I can recommend a couple of good books if you are so inclined. “Surviving Prostate Cancer” by Dr. Walsh is a lengthy tome but filled with great info - but it has a surgical bias. “Invasion of the Prostate Snatchers” by Dr. Scholz is a bit dated but valuable nevertheless. A more recent Dr. Scholz book, “The Key to Prostate Cancer” is also helpful. Dr. Scholz’ books carry more of an anti-surgery bias. Dr. Scholz also does YouTube videos and I highly recommend you search for those that are focused on material aligned with your case.

Best of luck to you and please let us know how you are doing.

Jim

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Hey Jim,

Thank you sir. I believe I still have the email from Bud when he told me he was a part of this group and I was so pleased to read the positive feedback he received. Jim, he never complained. “Is what it is Joe” is what he would say. Strong family man as well and he would be very pleased with his daughters and grandchildren. He now has 3.

Yes, Eddie did choose AS and had dealt with so many other health issues before that and fought them head on. Tough dude.

Your comments are incredibly invaluable and well received. Quite frankly, I have been a bit overwhelmed with “what’s next” and knew that joining this was the right move.

Thanks for the book recommendations.

Be well,

Joe