Biopsy results today

I had a needle biopsy (12 samples) 9 days ago prompted by a PSA of 4.1 and more specifically an increase in my PSA over the allowable amount in the last 12 months. The results show a portion of one sample tested positive for prostate cancer. The Urologists office has already scheduled me for a bone scan and a CT scan in 2 days and an office visit in one week to discuss the results and treatment. I am 60 years old and in otherwise very good health. The physicians assistant that made the call told me to research prostate cancer on the internet and write down all questions that I have after doing some research to bring with me for the Dr visit. Can anyone recommend the best place to do some research and maybe even what questions I should be considering asking. He did not give me any sort of number when he called to help classify how aggresive my cancer is so I really don't know anything more than I have posted. Thank you for your advice, Emerson

You can learn a lot just by reading past threads here on HealingWell.

Sorry to hear about your biopsy result, but one sample (out of 12?) generally represents a small volume of cancer.

Did they share with you the Gleason score? Factors that can affect your future action (or lack of action) will include the location of the cancer, its Gleason score, its volume, family history, and so forth.

Looking back, and putting the terror aside that usually is part of the initial reaction to a cancer diagnosis, if I had one core positive and a Gleason 6 tumor grade, I would get a second opinion on the biopsy to confirm that, and I would have to be forcibly convinced that the right course of action would be anything other than Active Surveillance.

A lot of recent threads here have dealt with choosing the best course of action after a postive biopsy. There are no easy answers, and there generally is no one "right" answer. Read, read, read, and go slowly. You only get one shot at doing the right and smart thing. Good luck to you. I think I would call his office and tell them you would like to know your Gleason score now, rather than later.

It's highly, highly unlikely that anything will show up on your bone scan or the CT scan (except old injuries, arthrites, disc degeneration, and other roadmaps of age).

As you can see in my "signature," my stats were significantly more serious than yours, so my options were much more limited.

It would also be helpful if you would tell us your age.

You mean www.yananow.net    for the main website, has patient histories over 1000 men and their journies. Get a copy of the pathology report, you might even be a decent candidate for A.S., depending upon findings, my brother had one positive core less than 5% and psa of around 1.0 or so and DRE suspecious, been over 8+ years now and no treatments, so far psa has been similar and it is his decision as to when and if treating it.

www.prostatepointers.org  for more info and groups for treatments

Emerson, sorry to have you join the group. you're getting some good start-up advice from these guys, but i have to admit i got a chuckle out of your note: my urologist loaned me a book to read, and recommended Walsh's book, but pretty much told me: that the stuff i read on the internet---don't worry about that stuff !! instead, read the book and ask him whatever comes to mind. i guess to a certain extent, he's right, there is some pretty crazy stuff on the internet. but this and the yananow sites really have great guys and great information, so take a deep breath, hang in there, read up a little, and keep us posted.
wishing you the Best !
bob

Yea. The first question I would ask is why the heck is this guy sending you for a CT scan? He should first discuss the biopsy results with you. If you one core of G6 a CT is a waste of your time and money. If your Gleason score is higher then it might be warranted. Again I am amazed they gave you no other information then what you say they did and are blindly sending you off for a bone scan.

I would first tell them you want a second opinion on the biosy results. Send them to Bostwick or Johns Hopkins or MSKK. I would then insist on seeing the second opinion report in writing from the other institution. If you have only one positive core and it is Gleason 6 I would find another urologist. Sending you for a CT scan is extremely premature at this point even if you are a Gleason 7.

Hello, Emerson.  Welcome to HW.  Sorry you have to be here but I assure you that you will find lots of great information here as well as caring support.

You have already been given some good info re Walsh's book and I also agree with ChrisR.  Beyond that I think that waiting a week to get your detailed biopsy results is unacceptable and that is what I would categorize as "arrogant medicine".  These are YOUR results and you should demand the detail immediately; there is no need to subject yourself to a week's anxiety.  My doctor called with the results one afternoon and I was in his office the next morning for a detailed discussion.  If your doc cannot make time for you immediately, then insist on a written copy of the biopsy results so that you can start your own research.  I assure you that there is enough knowledge by posters to this forum to give you a head start on interpretation if your doctor is not willing to make himself available to you.

Jim

Take your time, take a breath and learn all you can. You will have many options including AS. Start a journal and keep all your notes it. Start a folder and get copies of every test you get...PSA and blood tests, any scans, biopsy's, etc. You are paying for these tests and your are entitled to a copy of the results.

You can read what I went through by clicking on the link in my signature.

Good luck to you.

6% of 1 core, out of 12 samples, and a Gleason 3+3=6 is quite low. There is no need for you to rush into treatment so spend your time researching thoroughly your situation before deciding on a course of action. The fact that at least 50% of men your age will have evidence of prostate cancer (if they were biopsied) and, of that positive 50%, only 6% will die specifically from PCa shows that a diagnosis of prostate cancer is certainly not an automatic death sentence, even if if no treatment is undertaken. Do research active surveillance as one of your options as well as active treatment. The bone scan and CT occur as a matter of course but with a PSA of 4.1 I'll lay London to a brick that they will be clear.
Bill

I'm sure that almost everyone here wishes that they had your initial diagnosis rather than their own. As others have advised, take the time to understand the disease and your options.

Emerson, I know you are unhappy that you have prostate cancer but...you are indeed fortunate with those stats.  You barely have cancer. The scans are highly unlikely to show anything and many urologists would not even bother when looking at your diagnosis.  Some thoughts I have:

1.  Consider sending your slides to Bostiwck or Epstein for an expert second opinion.

2.  In addition to Walsh, read the books by Strum and Scholz.

3.  AS should be a viable alternative for you.  Physically this makes sense.  However, you need to be psychologically ready as well.  If you do choose AS, make sure your urologist is experienced in that approach.  This is "active" not passive.

4.  When looking at treatments, you should consult a radiation oncologist who specializes in brachytherapy as well as your uro-surgeon.  The studies show that brachy is equally as curative as surgery for a man with your stats but with considerably less chance of onerous side effects.

Good luck and keep us posted.

Jim

Hello Emerson,

I was diagnosed early 2012 with total PSA of 4.4 and free PSA 14%. Color doppler ultrasound found the tumor immediately. I am a strong supporter of color doppler ultrasound. One tumor contained within the prostate. All other biopsy sticks were negative. Gleason 3+3. Brachytherapy June 2012. 24 needles and 72 stranded seeds. I-125. Three weeks since seed implant and side effects are barely noticeable. Side effects should build through the second month then begin a gradual recession to nil around mid 2013. I was never seen by a urologist. I did all my own research and decision making. Made all my own contacts. I knew that if the cancer was contained in the prostate I'd go for Brachytherapy and if not I wasn't a good candidate for surgery anyway. At least that's the way I looked at it.

Good luck,
Robert

Emerson,
I should also mention that you should calculate your psa density. prostate size in cc divided into your psa; if it is less than 1.5 then you most likely have indolant PC. You should get your prostate size from your biopsy report. Your prostate size would have to be less than 26cc to be concerned with your psa of 4.
Bostwich labs also has a new test that can reliably identify indolant from agressive PC. You will have to ask for this special test and I would highly recommend it before making any treatment decisions.
JohnT

I may be pointing out the obvious, but getting a second opinion from someone in Nashville does not necessarily mean that you are changing doctors and getting treatment in Nashville ...