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Anybody have two biopsies?

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Posted 9/5/2007 2:02 AM (GMT 0)

     Here is why I ask.  My treatment is being dictated by my aggressive Gleason of 4+4. With a lower Gleason, I could opt for a different treatment.  One month ago my PSA dropped from 6.8 to 5.1.  What if my Gleason may now be lower?  I had my biopsy samples read by two separate hospitals including Dr. Epstein at Johns Hopkins, so I doubt if the reading from three months ago was wrong.  I sure would like to know if it changed.  Has anybody had two biopsies, and if so:

            Were your Gleason scores different on the second reading?

            How many months apart were they done?

            What was the basis that you had a second biopsy?

Posted 9/5/2007 2:54 AM (GMT 0)
Same_as_u

My PSA at diagnosis was 6.6 with a free PSA of 16% and a gleason of 4+3=7, but at the presurgery PSA was 5.3 but with a 12% free. The free score is an important component in the PSA that is often not reported to the patient. A Free PSA below 20% is a problem indicator and the lower the worse it is. What did your free % do between the two PSA tests?

If I had a Gleason of 8, I would not worry too much about a second biopsy. If another biopsy showed an 8, then you would be the same place and if it was a 9 then it would be worse. I don't personally think a second biopsy will help you much but only delay a decision.
Posted 9/5/2007 2:59 AM (GMT 0)
Selmer, many thanks for your painfully honest answer.

I have no idea why a PSA would change; therefore, I have no idea that a Gleason would or would not. From your beautiful logic, I had better treat this on the path I am going for the worst case scenario of 4+4. It just seems so inconsistent that my PSA drops, and my Gleason says aggressive??? You even went to the effort to read my past posts; I appreciate your insight very much.
Posted 9/5/2007 3:17 AM (GMT 0)
Thanks ldoun,

The delay has been built in with the lead time that it takes to see most of these medical people. I am now on schedule for 9/14 to talk with the radiologist who will hopefully do an IMRT. The best thing I had going is that this is supposed to be a slow acting cancer. The uro who did my biopsy on June 5, said that I should not wait until November. It sure would have been more peace of mind to have completed treatment before now.

My free PSA was 13% in November when my PSa was at its highest of 6.9. It was never printed on my results for my next two PSA readings. I suspect that since the blood tests were ordered by my PCP, he does not focus on that.
Posted 9/5/2007 4:36 AM (GMT 0)
Hey Walt,

My first fiopsy was inconclusive so I had a second one a month later. It showed cancer and was graded as 3+3. My PSA was 7.1. As soon as the uro said cancer, I said I want it out. One month to the day I had RRP and the patological stage was T2C Gleason 3+4.

I doubt that once cancer is seen in the biopsy if another biopsy will prove anything. Plus healing from the biopsy will delay treatment. Everyone is different but I would not want to mess around with it. One can suffer from analysis paralysis and die from cancer.

Good luck...

Jim
Posted 9/5/2007 12:34 PM (GMT 0)
Many thanks Jim,

You make an excellent point that I never realized - a biopsy means a delay for healing. After three months I hope not to have any more delays.

Walt
Posted 9/5/2007 2:28 PM (GMT 0)
Walt,
I had two biopsies, but for a different reason. My PSA was up and down for a year, and after several rounds of antibiotics, my first biopsy was negative. When my PSA was up again at my physical a year later, I repeated the process and after more antibiotics, a second biopsy found the cancer. I agree with Jim and think your assesment is correct. I don't think the cancer has gone away, and you certainly don't want a substansial delay in beginning your chosen treatment.
That said, if a second biopsy would ease your mind about a false positive, and if you could get it scheduled right away, a few days wouldn't change the odds very much.
Good Luck Walt, and keep us posted on your progress.
Best,
Mike
Posted 9/5/2007 3:19 PM (GMT 0)
Many thanks, Mike.

You summed it up very well. about all my question did was prove how little I know about the broad scope of pc factors. When I first came to this forum, I actually thought that I would have my prostate removed similar to having my appendix taken out. What a shock as I started to learn the differences.
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