The transperineal biopsy that turned the MRI's suspicion into a diagnosis — Grade Group 2 — plus the two features that raised the stakes and the genomic test that put a number on the risk.
What the biopsy found
Of the 13 containers, 3 contain cancer; the other 10 — including every core on the left — are benign. The grade is the same at all three positive sites: Grade Group 2 (Gleason 3+4=7) — mostly the less-aggressive pattern, with a smaller amount (about 20–30%) of the more-aggressive pattern 4.
Cancer at the right mid PZPL, right lateral, and midline base.
Every left-sided core — apex, base, lateral — came back benign.
- Right mid PZPL — the dominant site: 4 of 5 cores positive, up to 40% of a core (4 mm); cribriform pattern.
- Right lateral — 1 core, ~30%; cribriform pattern.
- Midline base — 1 core, ~30%; intraductal carcinoma (IDC-P).
Diagnosis confirmed by immunostain (PIN4 / AMACR).
Grade Group runs 1 (least aggressive, often just monitored) to 5 (most aggressive). Grade Group 2 is the second-lowest — but two extra features, below, shift the risk.
Two features that raised the stakes
The grade number isn't the whole story. The pathologist flagged two patterns that behave more aggressively than Grade Group 2 alone would predict:
Cancer cells filling pre-existing ducts — in the midline-base core.
Sieve-like sheets of cancer cells — in both right-side cores.
Neither changes the Grade Group number — but together they shift the risk category and take active surveillance off the table. They're also the reason a second-opinion pathology read was worth getting (see below).
The genomic read — Decipher
Decipher is a test run on the biopsy tissue itself (block 12A) that reads the tumor's genes to estimate how aggressively it's likely to behave — a number independent of the Gleason grade. It came back on June 18.
The 0.47 score lands in the intermediate band (the scale runs 0 to 1). These are statistical estimates, not certainties — but they line up with the picture from the grade and the adverse features, and they're one of the inputs feeding the surgery-versus-radiation decision.
Where this leaves the staging
The biopsy points to localized disease, and the imaging agrees:
Full detail on the imaging is in the MRI report and the PSMA PET/CT report. A biopsy samples tissue rather than staging the whole pelvis, so the “localized” read leans on the scans for the parts a needle can't reach.
What's still being read
Everything above reflects the Northwell pathology. MSK is running its own independent re-read of the same slides — and that re-read hasn't been released yet. Given the cribriform and IDC-P findings, a second-opinion read on the slides is exactly the kind of thing worth getting, and it could refine the grade or the risk picture. This page will be updated when MSK's re-read lands.
Grade Group 2 with adverse features and an intermediate Decipher score points to definitive treatment — surgery or radiation — rather than monitoring, with the disease looking localized on every test so far. For the personal narrative around this result, see the pathology update and the biopsy-day update.
The diagnosis, the features, and the number behind the risk.