Today’s Telehealth Conference re Biopsy Results & Next Steps
BOTTOM LINE UP FRONT: On the whole good news, as it could have been a lot worse, and I’m glad I caught this when I did. There is no imminent threat, and the cancer hasn’t spread outside the prostrate. Except for one small exception the cancer that is there is low-risk, slow-growing and non-aggressive. Next step is a type of genomic testing called ‘decipher testing’ on the cancer they found, and based on the results of this testing, it is likely I will either just have to keep an eye on it for the time being (”Active Monitoring’), or have my prostrate removed (prostatectomy). My next telehealth conference with him is likely to be on December 20 after the results of the genomic testing, at which point we will know more about next steps.
- He confirmed I have early stage, localized (confined) prostate cancer. It is highly unlikely it has spread outside the prostate (= no imminent threat)
- He confirmed I’ve also got Benign Prostate Hyperplasia (BHP – just a fancy way of saying enlarged prostate), but this is common for men my age and the recommended treatment is continuing to take Tamsulosin.
- the majority of the biopsy samples that showed cancer were of the low-risk, slow growing, non-aggressive type (Gleason score of 3+3).
- Only one sample – and only 10 percent of that sample - showing aggressive growth (Gleason score of 3+4)
[NOTE: A Gleason score of 3+3 is Grade Group 1 and is low risk, indicating low-grade cancer, where the cancer is less aggressive and likely to grow and spread very slowly. If the cancer is small, many years may pass before it becomes a problem. Low-grade cancer may never need treatment.
A Gleason score of 3+4 is Grade Group 2 and is Low-to-Intermediate Risk, with a prognosis of intermediate grade cancer, i.e. moderately aggressive and likely to grow and spread at a modest pace. If the cancer is small, several years may pass before it becomes a problem To prevent problems, treatment may be needed) END NOTE].
My Risk Group is Favorable Intermediate Risk (on the scale of: very low – low – favorable intermediate – unfavorable intermediate – high – very high)
My TNM score is T1C, which means cancer found in one or both sides of the prostate. My cancer is bilateral, on both sides of the prostate, which is the case in over 80 percent of prostate cancer, which rules out focal therapy
The doctor said the next step is a type of genomic testing called ‘decipher biopsy,’ which measures/tests the gene expression of the tissue (which tells how aggressive it is). The results should be available in 4-6 weeks.
Based on the results of the genomic testing, the treatment options would likely range from active monitoring to surgery to remove the prostate (prostatectomy):
- Active monitoring entails taking PSA tests every six months, MRI every year or two, and biopsy every two to four years.
- Surgery is more effective than radiation for those with an expected long life (long in the context of people w/prostate cancer, who tend to be old. So in this case ‘expected long life’ means over 10 - 20 years I think), and surgery has a higher rate of cure than radiation. Surgery first also leaves the option for future radiation, but radiation first causes scar tissue which makes subsequent surgery more problematic. As such, surgery is preferred over radiation in cases like these.
So, next step is my talking to the State Department Medical Team to see what my options are in terms of staying here or returning imminently to Jordan. My preferred option is to go back to Jordan and do the next telehealth conference in 4-6 weeks from there, then fly back here for treatment if needed, but I don’t know if State Department will allow a subsequent flight back and pay for a hotel stay. If not, I guess I will have to do it out of pocket. We’ll see.
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