Advice for Prostate Biopsy Results

Hi all,

I had my first biopsy this past Monday. My uro prefers to discuss results in person and not on the phone. I’m scheduled for this meeting Dec 8. Can anyone help me with what I should expect in the discussion and what should I be prepared for or to do/ask? If the Dx is PC or the Dx is Negative, I have no idea what to expect in this discussion. And what is the “whats next”?

The topline information is whether any of the biopsy cores came up positive for cancer. If they did, how many were positive, what was the percentage of cancer in each, and what was the Gleason score for each?

If you do test positive for cancer, how you proceed may depend a lot upon the severity of the diagnosis. My guy's practice is to have a follow-up meeting three weeks after presenting the diagnosis to answer questions and consider options. Since I was diagnosed only with what he described as "a whiff of prostate cancer," I was ready to proceed on the spot to active surveillance, and I saved any questions I had for our first surveillance appointment three months later.

One thing you might be prepared to do is to ask for (and insist upon if necessary) a second opinion on the slides from a pathologist who has a particular specialty in reading prostate biopsy slides, such as Jonathan Epstein at Johns Hopkins. (I have to confess that I didn't do this, but I would have if the results had been such that immediate treatment would have been a serious option.)

Another good thing to get in the event of a cancer diagnosis is an idea of the timeframe you have for making decisions regarding treatment. Even with a serious diagnosis that indicates that near-term treatment is warranted, you should have (and should take) the time to catch your breath, and research and consider your options (and talk to various people) before you proceed.

If there's no cancer found in the biopsy you should be getting an idea from your doctor on his idea of what might be causing the PSA rise, and how he wants to proceed from this point on. Is this BPH or something other non-cancerous condition? What does he want to do with regard to further testing (PSA readings, and a possible additional biopsy). What's he ruling out as a possibility, and what's most likely?

Good luck with the results. I'm actually getting my biopsy results a day ahead of you for the follow-up biopsy I had earlier this month.

Great questions!
A lot will vary depending on your Uro’s style, the biopsy results, and your relationship with the Uro. In my case, he was meeting my wife for the first time and had a bagful of stinky news to deliver, so he started with awkward small talk before dumping the contents of the bag in our laps. He only went over the highlights of the pathology report, then briefly discussed options before strongly recommending surgery.
Instead of worrying about how the visit might go, focus on what you should insist on before you leave the Uro’s office:
—A close, careful, line-by-line review of the pathology report, regardless of whether it showed any PCa. Don’t be satisfied with on overview. Get a copy of the report for your records.
—If PCa, a description of all treatment options, highlighting the pros and cons of each in light of your pathology.
—A treatment recommendation. Keep in mind that Uros are surgeons.
—If PCa, I’d want to talk to a radiation oncologist before making a treatment decision.
—You may want to have your slides sent to a second lab, e.g. Epstein at JH, for another reading. I’m sure others on HW more knowledgeable than I will give you more information about that.
Do your homework on Gleason, staging, and treatment options before Dec 8 so that you can participate meaningfully in the discussion and can recognize if Uro is glossing over something.
I’m a relative newbie to PCa. Listen closely to what the vets may have to say.

You've gotten good information and thorough answers to your questions.
Only thing I'd add, is that it's not unusual for a Uro to always plan on giving the results face to face. The Uro I went to, told me on the day if the biopsy, that I should make an appointment to come back, as his protocol is to have an I. Person discussion on the results whether positive or negative. (My results were negative for cancer, first biopsy). In fact my second biopsy, with a different Uro, and it was positive for cancer, and I was told over the phone , 3 days after the procedure.
So While I don't want to give you false hope, don't jump to conclusions that might lead you down a black hole of fear and panic. Keep your imagination in check.

Everyone, thank you! This is great input and I feel more prepared now. You are just great people.

Joe you are getting sound advice. Either way I’d bet your dr, wants to sit and explain the results...the week wait sucks,...I have done it twice and possibly a 3rd time coming up. I think the word “cancer” numbs us. Don’t get ahead of yourself but also remember that IF and that’s a big if...they find anything you are in good health and will be cured...
Lots of options and just keep reaching out with any questions or concerns,,,,fingers crossed that it’s just prostitis or bph.

Thanks again everyone. I put the list of questions together below based on what everyone suggested for my results review meeting with the Uro. Thought I would share it. I get my results on Friday this week.

I live in the Baltimore Washington area. If my results are positive, I would welcome any recommendations in this area for the various treatment options. Also, if there is a "THE" place to go for treatment, I would welcome your thoughts. Hopefully, I'm getting ahead of myself.....but I like to be prepared.

What to expect:
Dr. will spell out in detail what the biopsy revealed and what your treatment options are. Regardless of results, request a line by line review of the pathology report.

Positive Results
• Did any biopsy cores came up positive for cancer?
• How many were positive?
• What was the percentage of cancer in each?
• What was the Gleason score for each and staging?
• What is the severity of the diagnosis?
• What treatment options do you recommend?
• What are the pros and cons based upon my specific pathology report?
• What is the timeframe I have for making decisions regarding treatment?
• I would like to have a follow up visit in a few weeks to ask more questions and consider options.
• I would like your help in getting my slides reviewed by Dr Jonathan Epstein at Johns Hopkins.
• Do you have recommendations on where I can research my options?
• Can you recommend a radiation oncologist that performs SBRT and other radiation treatment options?
• May I have a copy of my report?


If negative results:
• What might be causing the PSA rise?
• Is this BPH or something other non-cancerous condition?
• What's are you ruling out as a possibility, and what's most likely?
• How should I proceed from this point on?
• What do you want to do with regard to further testing (PSA readings, and a possible additional biopsy).

Good luck Corvette Joe--you're well-prepared. All I'll add is that my uro also would always schedule an office review since even if the biopsy wasn't positive, he wanted to discuss next steps. Let us know what happens!

Cajun Jeff said...
Corvette Joe, looks like you have a great list of question to ask. You meeting is tomorrow and we will be waiting for your report. The guys have given you some great advise.

On a side note. What kind of Vettte do you have. My screen name has been changed to Cajun Jeff at the request of some of the guys on HW but my former screen name was Corvetteman3. Yep Im a vette guy as well. I am still driving my 2001 vette that I purchased in 2003. I had an 89 coupe and 90 vert at the same time, also had a 77. Love those plastic cars.

Best of luck with you visit.

Cajun Jeff

Jeff, I have a 2006 an love it. Looking forward to seeing the mid engine coming out.