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JHU second opinion report

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Posted 6/4/2018 12:26 PM (GMT -5)
Here's what I just received:

GU PATHOLOGY CONSULTATION SERVICE
JONATHAN I. EPSTEIN, M.D., DIRECTOR
ANDRES MATOSO, M.D.
TAMARA LOTAN, M.D.

PROSTATE:

A. SMALL FOCUS OF PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE
GROUP 1), INVOLVING LESS THAN 5% OF ONE (1) CORE. SEE NOTE.
B. SMALL FOCUS OF PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE
GROUP 1), INVOLVING LESS THAN 5% OF ONE (1) CORE. SEE NOTE.
C. BENIGN PROSTATIC TISSUE. BENIGN PORTION OF SEMINAL VESICLE/EJACULATORY
DUCT.
D. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) INVOLVING
20% OF ONE (1) CORE. SEE NOTE.
E. BENIGN PROSTATIC TISSUE. BENIGN PORTION OF SEMINAL VESICLE/EJACULATORY
DUCT.
F. BENIGN PROSTATIC TISSUE.
G. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) INVOLVING
40% OF ONE (1) CORE.
H. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7 (GRADE GROUP 2) INVOLVING
30% OF ONE (1) CORE. (LESS THAN OR EQUAL TO 5% GLEASON PATTERN 4).
I. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) INVOLVING
70% OF ONE (1) CORE.
J. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7 (GRADE GROUP 2) INVOLVING
70% OF ONE (1) CORE. (LESS THAN OR EQUAL TO 5% GLEASON PATTERN 4).
K. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7 (GRADE GROUP 2)
DISCONTINUOUSLY INVOLVING 30% OF THE TOTAL FRAGMENTED SPECIMEN. (LESS THAN
OR EQUAL TO 5% GLEASON PATTERN 4).
L. BENIGN PROSTATIC TISSUE. BENIGN PORTION OF SEMINAL VESICLE/EJACULATORY
DUCT.
Posted 6/4/2018 12:40 PM (GMT -5)
Looks quite similar to what Emory reported on the first reading (which I’ve cut&pasted here):
G7(3+4) 40% GC2
G7(3+4) 70% GC2
G7(3+4) 70% GC2
G7(3+4) 25% GC2
G6(3+3) <5% GC1
G6(3+3) <5% GC1
G6(3+3) 20% GC1
G6(3+3) 30% GC

JHU downgraded one core from 7 to 6, and gives you more detail. I’m not knowledgeable enough to comment on whether that changes your options. Others will be along soon with good advice, I’m sure.
Posted 6/4/2018 12:58 PM (GMT -5)
Thanks Saipan. I thought it was marginally better. I think that I've alluded to another issue taking priority, and most of my mental capabilities. I'm dealing with a recent estrangement from my daughter, age 22. Compared to that, for me, this prostate issue is currently taking a backseat to that pain. It just gets worse and worse. Not to denigrate anyone's condition here. I think I'm leaning toward radiation; but there is something very appealing about surgery, and getting this thing out of me. We work and worked at the CDC; interestingly the MDs with the ailment that I've spoken with have all chosen surgery. Just anecdotal, not scientific survey data by any stretch. Cheers all.

Post Edited (Steve Smith) : 6/4/2018 12:05:24 PM (GMT-6)

Posted 6/4/2018 1:32 PM (GMT -5)
Steve,
You’re relatively fortunate that you have plenty of time, with 3+3s and 3+4s, to take care of family matters first. Be sure you’re in a calm place mentally before you make any irrevocable treatment decisions.
I wouldn’t put too much stock in what treatment modality the MDs you know are choosing. They have their own biases, and their pathology profiles may differ from yours. Keep doing your research, consult with specialists in each particular therapy, and be honest with yourself about your personal priorities and needs. There’s no one-size-fits-all with this stuff.
Best wishes,
SP.
Posted 6/4/2018 8:45 PM (GMT -5)
Steve,

That is a decent report, with the G7 you probably fall into the 'treatment eventually' category--but you do have time to do the research into treatment choices-and wrap your head around your personal issues.

I looked back at your other thread, and what you said about Emory is a concern--they are still listed as one of top hospitals in the country.

Take some time to research the treatment options--I think most of us would say that when we made the decision, and it was the right one for us, we relaxed. The same will be for you as well. Hang in there.
Posted 6/5/2018 1:02 PM (GMT -5)
Thanks Saipan and Halbert!

Yes Emory has contributed to my wife's survival for ten years with uterine leiomyosarcoma. Many, many surgeries, mostly in lungs, multiple chemos, and now targeted radiation. In the last few years the waiting rooms have changed; sometimes I wonder if we are the only paying customers. Don't mean that as bigotry, just observation, and is very likely a result of the expansion of medicaid in Georgia. Unfortunately the staffing has changed too, and that concerns for reasons of the weakest link in the service chain. Some of this is generational: all the younger employees have a cell phone permanently attached to one hand.

Post Edited (Steve Smith) : 6/5/2018 12:11:06 PM (GMT-6)

Posted 6/5/2018 7:27 PM (GMT -5)
Hi Steve,

Your Gleason score is not too bad overall. I hope you are able to take care of your wife and patch things up with your daughter. I think they both really need you.

Charley
Posted 6/7/2018 10:58 AM (GMT -5)
Thank you Charley
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