3rd Biopsy

Received a call from my Uro's office today. Last week's biopsy showed 10 cores now involved with G6. Last time there were only 3. Here is the thing; on this test, they took a total of 40 samples. 16 were taken the time before. It seems that every time they do a biopsy they do more and more. I am not sure if this is because it is standard practice or if the practice is evolving- a question for the doc next week.

Another question or two: Does the test indicate that the other side of the gland is now involved? According to the PA I spoke to, yes. Do the lesions shown in the last MRI test positive? I thought the answer was yes, but it wasn't clear. The PA was actually driving when he called with the results (odd).

A second opinion with Epstein is looking good at this point.

So I will be asking the questions again and formulating some others between now and next Wednesday. Any suggestions are welcome. As always, I appreciate everyone's support.

Depo

I agree with Michael- they looked VERY hard and all they could find was a GS 6. That's pretty good. 40 cores usually means a transperineal template-mapping biopsy, so they have a pretty good picture now of exactly where the cancer is. If so, that's the gold standard of biopsies - even better than an mpMRI-targeted biopsy.

Thanks guys. Looks like more AS for at least a couple more years. I have to learn more about the transperineal template-mapping biopsy.

I tried to get an idea if the G6 was growing. The PA told me that it is like using a pepper shaker. It is kind of spread around a bit. He said this is very common.

Dr. Patel's take should be interesting. I will also get the official report.

When I see 40 cores the first thing that comes to my mind is Swiss cheese. I hope you were sedated for the biopsy.

OK. Patel's main points:

The G6 is growing. Not fast, but it is growing.

Men in my situation usually have G7 by now.

The more biopsies, the harder it is to spare the nerves (but not as hard if radiation was in history).

Next steps: #1- Epstein second opinion. #2- Oncotype genome testing.

Apparently the genome can change over time.

The 40 samples were actually just 14 with multiple triggers or something. Still not sure about this, but it wasn't transperineal.

I was told through a diagram by the Fellow(met just before the Dr.) that everything was still in the lower right quadrant and that nothing has really changed. The Dr. had a different take.

Allen, I told the doc that I had already had the Prolaris and that is what he told me- with a flair of danger to his voice. Normally I would be a bit angered by the dramatic tone. I once had a rift with a urologist for wanting to put me on allopurinol when I was in my 20's. I refused, he cursed at me and I left.

Post Edited (Depov) : 8/2/2018 3:01:04 PM (GMT-6)

Yes, but he didn't say it always does.

I will have to study the results to see how many cores out of 14 are actually involved. Just had the test sent to me.

I'm no doctor, but I don't quite understand what appears to be the ominous tone in the doctor's voice. You have a low volume of a low risk G6 cancer. On one hand, it does appear to be growing, but given the sampling error in a biopsy, it's also hard to know if that's noise or not. When he says most guys would have a G7 by now...I'd take that as a good thing. If that's true, then it means your cancer is growing more slowly than "most guys."

As to his point that multiple biopsies make nerve-sparing surgery more difficult (which frankly I don't understand), that's only a problem if you have surgery. With a G6 or G7, the cure rates will be about the same with surgery or radiation.

Clearly, you need to do what is best for *you*...but as someone about the same age as you, I'd want to hold off on treatment for as long as I could.

Looking at the actual report that just arrived, it is kind of hard to determine the percentage of involvement. 4 out of 14 samples have positive involvement. They are, 5%, 10%, 50% and 70%. Within those, there are sub-samples, like 4 out of 5 for the 70% and 3 out of 4 in the 50%. Make sense?

All involvement is in the Right Lateral, Right Lateral Base and the Right Base (seem to be forgetting another region).

Now waiting on second opinion from Epstein and the Oncotype DX.

I feel like I am looking for trouble and that this is all a waste of time and money. But I suppose it is better to be safe at this point.

A number of possibilities - Policy change, the person who told you to call was wrong, or the person who answered the phone may not be allowed to give test results over the phone.

There are some privacy laws on the books that make medical offices reluctant to give any medical information over the phone.

My current health provider won't list past PSA test results in their on-line portal because they claim California law prevents. They will email me the results through the secure portal or tell me in person but never over the phone.

Andrew

InTheShop suggested "A number of possibilities - Policy change, the person who told you to call was wrong, or the person who answered the phone may not be allowed to give test results over the phone."

A mess up is possible. I had a bad experience with receiving my original biopsy results.

I had the biopsy on a Thursday and was told they would call with the results early the next week. That week went by and I heard nothing. We got into the next week, nearly 2 weeks out, and I was getting pretty anxious so I called. All I could get was a voice mail that said that would try to get back to me within 48 hours.

I went online and looked at my records and saw that the results were available 4 days after the biopsy!

I didn't know if I had the guts to look at them myself but screwed up the courage and clicked. I didn't understand anything except the word "carcinoma" so I used "Dr. Google" to help me understand what a Gleason was and some of the other findings.

I then called my primary care doctor's office, got right through to his nurse, and asked if this was something that someone was supposed to explain to me. She checked, called back, and said urology would be calling me before the end of the day. The call came in the next day while I was gone. They talked to my wife and while not talking about the results they wanted to make me an appointment for the end of the next week. My wife said that wasn't acceptable and they found they could see me in 2 days.

The urologist was VERY apologetic. It turned out that my results were sent to a physician's assistant who did nothing with them. While I really do like my urologist, I lost confidence in the hospital even though we went through my wife's cancer treatment there 2 years previous with no problems. I elected to go elsewhere which, since I am in Montana, meant out-of-state. I went to Cleveland Clinic and couldn't have been more impressed.