Biopsy results

Allen,
What I don't understand is why the Systoscopy does not show up the symptoms caused by an enlarged prostate pressing on the urethra.
James

Regarding Saw Palmetto ..I ran out of it a week ago and didn't replace it.
Now I notice more pain urinating and when I have to go, I have to go.
So, it was helping more than I thought.

James

PNI has not been included in anyone's risk stratification yet to my knowledge.

Jimi,
Thanks for your comments.
ECE might be a factor with surgery,
on one MRI possible ECE was mentioned
2nd MRI said NO
and Biopsy says NO EPE ..which I presume is the same as ECE?
40% risk of acute urinary retention with LDR added to existing urinary issues does not make LDR very enticing either.
The significance of PNI seems to be open to debate
James

My case review recommends Surgery and not Brachy because of the 5 positive cores and existing urinary conditions.
Stage is T2B.
Gleason 7 (3+4) ...two of the cores have a (4) component or does that matter?

Minimal ECE was mentioned
It seems unlikely that the right nerve bundle will be spared.
I thought one of the advantages of open Surgery was that the Surgeon could feel near the bundle site
and then decide on sparing or not
but instead it seems to be a pathology decision.
Does the loss of one nerve bundle double the risk of ED?

Thanks for your thoughts.
James

Age 59
PSA
2011 5.6
2012 5.4
2013 5.9
2014 6.4, 8.1, 6.3, 8.2
Gleason 7 (3+4)
5/12 positive for Adenocarcinoma
Percentage: 20%, 10%, 10%, <5%, <5% ...on right side of PZ only
Stage T2B
HGPIN: Yes
Perineural Invasion: Yes
Lymp, Seminal, EPE No

James, I would think minimal ECE is the same as being minimally pregnant. If you lose a nerve bundle you will have ED issues, period. Prior to my surgery I was told they would spare the RT bundle, didn't happen. Have a good chat with your surgeon so you completely understand what might and might not take place.

Cheers, Doug

Hi Andrew,
It looks like Surgery as the RO on the team review was not recommending Brachy.
I'm just wondering if 3T MRI higher resolution images were performed
would that effect sparing the right nerve bundle
as there were no b 1400 or higher res. images performed on the original MRI.


Doug,
I like that minimally pregnant bit.
It does surprise me that another MRI was not mentioned to help decide the nerve question
perhaps when it's that close removal is regarded as the safest option.

Michael,
I understand there were 3 Urologists, pathologist and radiation oncologist at the review.
I was told that 5 positive cores and urinary problems rule out Brachy
there are hemorrhoid & Diverticulitis issues aswell.
Brachy was originally my preference.
I don't want the right nerve bundle removed simple as a precautionary measure
I guess it's a difficult call for the Surgeon aswell.
I did get a second opinion on the MRI and I was told it might not be possible to save the right nerve bundle
and that it also depended on the skill of the Surgeon

James

I can see how the urinary and other issues might mean that brachy is not a good choice. That said, I've never heard that five core disqualifies you from brachy. Brachy is actually the treatment of choice for high risk guys, so that doesn't make sense. I was told (erroneously) early in my treatment that I didn't qualify for brachy since my cancer was in both lobes of my prostate.

I hope I'm not hammering on something you've already made up your mind on, but since you wanted brachy and one nerve bundle won't be spared, have you actually talked to a brachy specialist? Maybe they can speak to the urinary and other issues better than anyone in your consult group could. The five cores comment just puts an element of doubt in my mind, particularly with the wrong info I received.

Hi Doug,
Well that seems to answer the nerve question, your saying the policy is ''if in doubt take it out''
The tumor is on the right side and all biopsy cores on the left were clear
so the left nerve bundle seems to be ok.

Michael,
I understand and appreciate what your saying.
I originally thought Brachy LDR would be perfect,
PC treated, nerves intact, one day in Hospital & back to work much quicker ..as I work for myself that's important too.
I've had to rethink the Brachy option as I'm being told my urinary conditions will be worse after Brachy
and I think it was mentioned here about 40% urinary retention risk with LDR
and I really don't want that. Existing Bowel issues can be aggravated aswell.
The Brachy meeting could take another month but I want to see him first before I decide
and I will ask him about urinary issues

Allen,
I asked that very question because I remembered you mentioning it previously
I was told having the Pathologist available during Surgery is not an option.
Those post Surgery erectile function percentages are poor.

James

Hi Halbert,
I don't have any ED history either but I take it you are referring to only a 10% chance of post surgery
ED problems based on both nerves being spared.
If the nerves are spared then those are excellent percentages for no ED problems.
The policy seems to be a bit like what Doug referred to ...in other words if in doubt take it out.
James

James they really can't make a decision about the nerves until they are in there. Pre surgery I was told the right nerve would be spared when I asked post surgery the Surgeon gave me a quizzical look and said no, that was never the plan. What happened was the Uro who told me it would be spared told me prior to the review of my case. After the surgeons had reviewed my case (pre surgery) they determined that the nerves could not be spared, I was not told. Probably wouldn't have made a difference for me with my prognosis.

Cheers, Doug

Hi Everyone! Routine check-up in Jan 2015 showed elevated PSA. GP recommend URO. Uro did another PSA to confirm not an error. Just found out 2 weeks ago my biopsy results. Would like some feedback!

12 Cores / 12 cores positive
Left Lateral - PA in 1 of 1 core, Gleason 3+3, 65% of tissue, Max dimension is 8.0MM, PI or LVI not present
Left Lateral Mid - PA in 1 of 2 (?) Cores, Gleason 3+3, 25% of tissue,Max dimension 5.0mm, PI or LVI not present
Left Lateral Apex - PA in 1of2 (?) cores, Gleason 3+3. 10% of tissue, Max dim - 3.0MM, PI or LVI not present

Left Base- PA in 1 of MULTIPLE core biop, Gleason 3+3, 65%, Max dim - 7.0MM, PI or LVI not present
Left Mid - PA in 1 of 1, Gleason 3+4, 35%, Max dim - 7.0MM, PI/LVI not present
Left APEX - PA in 1 of 2, Gleason 3+3, 25%. Max dim 4.0, PI/LVI not present

Right Lateral Base - PA in 1of1, Gleason 3+4. 5%of tissue, Max Dim-4.0MM, PI or LVI not present
Right Lateral Mid- PA in 1 of 2 cores, Gleason3+3, 20%, Max dim - 5.0MM, PI or LVI not present
Right Lateral Apex - PA in 1of1, Gleason 3+4, 20%, max dime - 5.0, PI/Lvi Not present

Right Base - PA in 1 of 1, Gleason 3+3, 25%, Max dim - 6.0mm, PI/LVI not present
Right Mid - PA in 1 of 1, Gleason 4+3, 35%, Max dim - 5.0, PI/LVI not present
Right Apex - PA in 1 of 2, Gleason 3+4, 25%, Max dim - 5.0, PI/LVI not present

PSA Jan 2015 - 6.0
PSA Feb 2015 - 6.1

DRE - Negative

Prostate Size - 32g

Bone scan/CT scan (Pelvic/Adominal) Negative

Recommended Dr. Vipul Patel for Robotic Surgery. Pending appointment with Dr. Patel

Masbirdes and members, please note that I started a new thread on this. Jim

Post Edited (Masbirdies) : 4/3/2015 10:54:43 AM (GMT-6)