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Brian Moody

Trying to understand it all

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Brian Moody

Hi to all,

 

I am new here as you all would be aware, and it's great to see such a group supporting and sharing as it is something that would truly benefit us all I am sure, thank you one and all. 

 

But what this below means is that I am at a lose as what all means,

any input to understand it all would be greatly appreciated     

 

  

Dear Brian

 

  1. Your Gleason grade was 8 (out of 10). Cancer was seen in one of the eight biopsy sites.

                I’ve attached your report below (and highlighted the grade).

That is “worse than average” but also that was 8 years ago (and cancers typically get worse over time)

 

  1. PSA = 4.1 (5.2.2020), compared to 3.3 (12 months ago) and 2.5 (3 years ago)

 

  1. There is an appointment for you to see me 24.3.2020 at 10.45

 

All the best

Sean

 

Dr Sean Bydder

 

           H I S T O P A T H O L O G Y    R E P O R T

SPECIMEN:

A. Right apex.

B. Right mid lobe.

C. Right base.

D. Right transitional.

E. Left apex.

F. Left mid lobe.

G. Left base.

H. Left transitional.

 

MACROSCOPIC:

A. Two thin pale tan core biopsies 5 and 11mm. (2p/1b/nr)

B. Three thin pale tan core biopsies 3, 5 and 7mm. (3p/1b/nr)

C. Five thin pale tan core biopsies from 2 - 8mm. (5p/1b/nr)

D. Two pale tan core biopsies 6 and 8mm. (2p/1b/nr)

E. Three pale tan core biopsies 4, 7 and 15mm. (3p/1b/nr)

F. Two pale tan core biopsies 12mm each. (2p/1b/nr)

G. Two pale tan core biopsies 17 and 18mm. (2p/1b/nr)

H. A pale tan core biopsy 17mm. (1p/1b/nr) (Vasiliev/Davidson)

 

MICROSCOPIC AND CONCLUSION:

A. Right apex:  Benign prostatic parenchyma.

B. Right mid lobe:  Prostatic adenocarcinoma with glomeruloid morphology,

Gleason grade 4 + 4 = 8, involving 2mm of a total 13mm (15% involvement). 

There is no evidence of perineural invasion.

C. Right base:  Benign prostatic parenchyma.

D. Right transitional:  Benign prostatic parenchyma.

E. Left apex:  Benign prostatic parenchyma.

F. Left mid lobe:  Benign prostatic parenchyma.

G. Left base:  Benign prostatic parenchyma.

H. Left transitional:  Benign prostatic parenchyma.

 

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Nev Black

Brian, welcome to our Support Group.

I was diagnosed in 2009 with a Gleason Score of 4+4 and a PSA of 5.8

My urologist told me I didn't have to make a decision the day I was diagnosed.  From my personal, non medical position, you have a bit of time to talk to other medical professionals before you decide on which treatment you prefer.

That is not permission to do nothing.

My cancer returned a couple of months after my prostate was removed.

10 years after diagnosis and with ADT my PSA is still undetectable. 

 

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Brian Moody

 Hi Nev,

 

As you can see from my post that report is 8 years old, my psa at last bloods was 4.0 21 days ago from 0.024 8 years ago.

 

Got a pet scan in a few weeks followed by a visit to my radiation oncologist about a week later.

 

🥵🥵🥵 The waiting ⁉️

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alanbarlee

G'day Brian,

 

Your status seems to be that you have a slowly rising PSA, 15% involvement (based on only 8 biopsy cores 8 years ago), with hopefully negative margins, and a Gleason grade  of more than 5-10% of  Grade 4. The '4+4' score in your case indicates that the relatively aggressive Grade 4 is dominant - at least 50% in Core B. The reference to 'glomeruloid morphology' is describing one of the aggressive sub-sets of Grade 4 disease. Ongoing and regular PSA monitoring following an adverse biopsy - especially a result 6-12 months prior to your last one - would have been informative.

 

You haven't indicated in this post what (if any) primary treatment you had following the adverse biopsy, but the reference to an upcoming visit to your radiation oncologist suggests that you may have had a form of radiation therapy back then.

 

The missing link in your information is imaging (anything from the past?), but the picture will be filled out by your upcoming PET imaging - hopefully the highly sensitive 68-gallium-PSMA-11 PET/CT scan. Based on your recent  PSA of 4, this scan should detect any significant residual cancer in the prostate bed, as well as possible metastases to bone, lymph nodes or organs like the liver and lungs. Something -either localised or metastatic prostate cancer cells - are slowly edging your PSA upward, and it's important to find out where these tumours  are and how limited or otherwise in extent  they may be. The result will then indicate how aggressive your treatment may need to be.

 

When you have the report, you might want to consult a medical oncologist who has a particular interest in prostate cancer, since there are a number of newer treatment options that will need to be discussed with you.

 

Keep us in the loop - and good luck!

 

Alan

 

      

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Brian Moody
5 minutes ago, alanbarlee said:

G'day Brian,

 

Your status seems to be that you have a slowly rising PSA, 15% involvement (based on only 8 biopsy cores 8 years ago), with hopefully negative margins, and a Gleason grade  of more than 5-10% of  Grade 4. The '4+4' score in your case indicates that the relatively aggressive Grade 4 is dominant - at least 50% in Core B. The reference to 'glomeruloid morphology' is describing one of the aggressive sub-sets of Grade 4 disease. Ongoing and regular PSA monitoring following an adverse biopsy - especially a result 6-12 months prior to your last one - would have been informative.

 

You haven't indicated in this post what (if any) primary treatment you had following the adverse biopsy, but the reference to an upcoming visit to your radiation oncologist suggests that you may have had a form of radiation therapy back then.

 

The missing link in your information is imaging (anything from the past?), but the picture will be filled out by your upcoming PET imaging - hopefully the highly sensitive 68-gallium-PSMA-11 PET/CT scan. Based on your recent  PSA of 4, this scan should detect any significant residual cancer in the prostate bed, as well as possible metastases to bone, lymph nodes or organs like the liver and lungs. Something -either localised or metastatic prostate cancer cells - are slowly edging your PSA upward, and it's important to find out where these tumours  are and how limited or otherwise in extent  they may be. The result will then indicate how aggressive your treatment may need to be.

 

When you have the report, you might want to consult a medical oncologist who has a particular interest in prostate cancer, since there are a number of newer treatment options that will need to be discussed with you.

 

Keep us in the loop - and good luck!

 

Alan

 

      

Wow Excellent Alan,

 

From the time of the biopsy i have only had about 18 months of hormone injections, and have had no other medical treatment since thanks Alan,

 

So I am looking forward (not) to the up and coming pet scan 

 

Brian

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Brian Moody

Wow Excellent Alan,

 

From the time of the biopsy i have only had about 18 months of hormone injections, and have had no other medical treatment since thanks Alan,

 

So I am looking forward (not) to the up and coming pet scan 

 

Brian

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Patrick Turner

I can see why Brian Moody can't understand a single word in the medical report about his Pca.

What Brian needs to know is what his cancer status is in simple terms for his PG, and where any spread has occurred if any.

In 2009 I was told "Gleason 9, 9 positive biopsy samples from PG, aggressive cells, young mans type of cancer."

CT scans later could not find any spread. First spread spots were found in 2016 with PsMa Ga68 PET/CT scans that can see more than CT scans.

My PG had so much Pca around it the urologist could not remove it, but he never said that was reason, cos' he is a bit useless giving any patient bad news. So I suspected I had a bad case, and I was in "1%" group of men who could not have RP.

But I had ADT and EBRT and treatment continues, but I am alive, and doing OK at 72 now.

So Brian needs someone to de-cypher the medico talk. I cannot.

Patrick Turner.  

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Admin

Jim Marshall (not a doctor) said ...

Eight years ago you had a small, aggressive prostate cancer.

Aggressive means:

  • more likely to spread to other parts of your body; and
  • more likely to eventually kill you.

The PET scan will be to see if it has spread.

Whether it has spread or not, your doctors will come up with a treatment plan so that the cancer does not get its own way.

 

... end Jim

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Brian Moody

Thanks very much for your responses folks very helpful,

 

Just as a possibility, if my pet scan shows that the cancer has spread, even to the bones,

 

Are there any suggestions as to what i can ask me oncologist on the day please.

 

Here's thanking you all once again in advance.

 

Kind Regards

Brian Moody

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alanbarlee

Hi again Brian,

 

Your radonc appointment will no doubt focus on the PSMA-PET scan results (and your Gleason grade).

 

If you have recurrence in the prostate / pelvic area only , then salvage radiation (IMRT= intensity modulated radiotherapy, or EBRT = external beam RT) might be considered.

 

If you have 5 or less metastases to lymph nodes and/or bones, and if they are not too big, then a few courses of stereotactic RT could be discussed. (This is highly focused high energy radiation: let's call it spot-welding).

 

Thirdly on the radiation front - and after an additional 'FDG'- PET/CT scan to check for any tumours that are not responsive to the PSMA-PET/CT scan - you and your radonc might look into a possible clinical trial with 177-Lutetium-PSMA-617.   

 

I mentioned before the advisability of getting a second opinion from a medical oncologist. Depending on the results, and with your Gleason grade (which potentially is high risk), you may quite possibly be recommended a treatment regime with one or a combination of systemic drugs - and there are a number of candidates that hit different tumour growth pathways which your medonc would likely  discuss with you.

 

We would be getting ahead of ourselves in exploring these options any further at this point. The next steps are your scan results and your oncologist(s) appointments.

 

Best wishes,

 

Alan

 

 

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