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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3594
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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I just had a 12 point prostate biopsy. Only one section was

Resolved Question:

I just had a 12 point prostate biopsy. Only one section was malignant, which was the Right Lateral Apex. The report said, "adenocarcinoma (Gleason 3 + 3 = 6) involving 2% of the specimen. Only one of 2 cores contain cancer." The other 11 samples were all found to be "benign prostatic tissue."

My questions are: 1) Is this considered a low level, caught early cancer?; 2) I read that a cancer in the Apex can cause some margin problems for the surgeon. Is that true and what does that mean?; 3)I'm 73 and was thinking of having the entire prostate gland removed to assure that there are not other trace cancers in the prostate. Is it foolish for me to go that far? If I did it, can it be done by Laparoscopic surgery to minimize recovery time?
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Tharun replied 1 year ago.
Hello

Have you talked to your urologist regarding the biopsy report?

Have they mentioned anything about active surveillance ?

How much is your PSA level?

Do you have any medical illness ?

Any heart problems ?

Please let me know

Dr.Tharun
Customer: replied 1 year ago.

My urologist said that the next step is a bone scan, which he is now scheduling. He said we will discuss treatment options after that. My PSA level is 6.0. I don't have any medical illnesses or heart problems.


 


I do have an enlarged spleen and a large growth in the spleen, but a PET scan said it was negative for cancer and was isolated and not causing any symptoms. Also, my prostate is enlarged, but my urination is good enough that I don't have to get up at night to go. Nothing is felt from my DPE.


 


The biopsy report said that the right lateral apex cancer was only 2%. does that mean it was found in only 2% of the sample? If that's the case, I supposed I'm lucky that they detected it at all? The Gleason is 3 + 3 = 6.

Expert:  Dr. Tharun replied 1 year ago.
HI Richard,

Biopsy always detects a part of the cancer and hence it is always little more actually in real time.But it is still considered very early prostate cancer.So early that you fall into low risk group in whom this cancer may never grow or progress.

There is new treatment strategy known as active surveillance for such group.Prostate cancer is followed regularly every six months with PSA,biopsy and rectal examination & at any signs of progression of cancer, treatment is started.It is found that treatment given at a later date when the cancer shows signs of growing has similar results as when given at a earlier date when the cancer was first detected.


This is also called delayed active treatment.The main aim is to find those patients in whom this cancer will never progress so as to threaten his life span.In such patients we can avoid the side effects of the treatment or rather over treatment.

Disadvantage of this method is that regular follow up is required along with regular biopsies.Also anxiety issues can be there knowing that we are living with a cancer inside us.

So the alternative is getting the prostate gland removed which is the gold standard treatment for such cancers.

The most preferred way is robotic prostatectomy.Excellent cancer control as well as pain control is achieved by this method.Apex can be well excised and is not a problem.

You need to talk to your doctor regarding these issues.Bone scan will rarely be positive in such early cancer and low PSA.

I hope this helps you take a decision.

Regards

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3594
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.