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EPE via biopsy?

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Posted 11/2/2015 12:19 PM (GMT 0)
In another thread, Sheepguy (I hope he's not Welsh) asked a question that has also been vexing me... Maybe we're both dumb but I wanted to pluck the question from that thread and seek clarification from y'all...

"How exactly is EPE diagnosed from a biopsy?"

As an aside is there ever internal 'ache' associated with PC or is my mind playing tricks on me...

Paul
Posted 11/2/2015 2:20 PM (GMT 0)
On further review I find I have conflated the pathology reporting for biopsies and post-operative examination. What I said is right for post-op but appears to be inaccurate for biopsies where probable EPE is inferred from a number of factors. PeterDA

If the pathologist sees prostate cancer cells surrounded by prostate tissues then that cancer is contained but if he sees prostate cancer cells surrounded by some other tissues, then he knows it has grown outside the organ. Diagnosing EPE from a biopsy sample is a hit-or-miss proposition -- the sample needle has to enter the organ at a location where the cancer has grown beyond the prostate -- but it does happen and is reported.

Generally an achy prostate is caused by inflammation -- infection, calcification, urine backing up into the ducts -- and seldom, if ever, by cancer. Of course one can have both.
Posted 11/2/2015 6:14 PM (GMT 0)
If biopsy finds PNI , it indicates potential adverse pathology including EPE. Otherwise biopsy can't find EPE, which is by definition outside the prostate.
Cancer pain comes from mets to bones otherwise there is no pain.
Bob
Posted 11/2/2015 6:27 PM (GMT 0)
Thanks Bob! There are definitely no bones in my ass, so that's a relief... uh oh that came out wrong... so did that... wink
Posted 11/2/2015 7:51 PM (GMT 0)
The biopsy report say EPE...not possible EPE due to PNI.

I still don't see how a biopsy can show EPE. The needle is inserted into the prostate and the "trigger" is pulled after positioning...you would have to have the needle outside the prostate when the sample is taken. I presume most uros doing a biopsy try to position the needle to sample only prosate tissue.
Posted 11/2/2015 8:14 PM (GMT 0)
sheepguy... reread my analysis on the other thread. Its all there and all correct.
Posted 11/2/2015 9:07 PM (GMT 0)
Logo, Sure , I understand,my question is the mechanics of identification and sampling to determine EPE.not what you think the definitions are, right or wrong.
Posted 11/2/2015 11:00 PM (GMT 0)
Sheep guy
I'd ask the doc who did the biopsy how he determined that EPE existed. Do you doubt the dx?
Bob
Posted 11/2/2015 11:08 PM (GMT 0)
Bob,
Well, yeah, I guess. The implications of EPE can alter treatment options so profoundly the pathologist/urologist better be right and it better make sense. If I was the patient I would ask the doc too. I have no idea how subjective the evaluation of EPE in a biopsy is.
Posted 11/2/2015 11:11 PM (GMT 0)
This is one case where I would surely ask for more opinions..Bostwick or no.
Posted 11/3/2015 2:19 AM (GMT 0)
Rest assured, that question will be asked of and answered by more than 1 doc to our satisfaction before any treatment is planned.
Posted 11/3/2015 3:17 AM (GMT 0)
Chat,
Cool...be sure to let the group know what they say...
Posted 11/3/2015 3:38 AM (GMT 0)
I've heard of guys being informed they had EPE after MRI guided biopsy. I found out after RP. Ugh! And ur right it is a whole different ball of wax. I'll be fighting for the rest of my shortened life. There is no cure for that.
Bob
Posted 11/22/2015 3:28 AM (GMT 0)
sheepguy

Thanks for asking the EPE via biopsy question . I have also been trying to find the answer to that question. Did you ever find an acceptable answer? Can you point me to that thread?


turn
Posted 11/22/2015 4:33 AM (GMT 0)
As I understand it...the pathologist sees cells other than prostate surrounding the cancer cells generally adipose tissue..I think. Presumably insertion of the biopsy needle before sampling is not thought to gather any extraprostetic cells or at least not enough to matter. I think.
Posted 11/22/2015 4:40 AM (GMT 0)
Of course that explanation implies that the "other" cells are inside the prostate, not outside...so maybe, as someone said , it is inferred by other factors such as PNI.. the importance of which is linked closely to percentage cancer in the biopsy cores according to to JH. So, hell, I don't know. :)
Posted 11/22/2015 7:14 AM (GMT 0)

Somebody said...
As an aside is there ever internal 'ache' associated with PC or is my mind playing tricks on me..

Pre-treatment, I had a constant dull ache in my pelvis area. Post-treatment it is no longer there.
Posted 11/22/2015 12:47 PM (GMT 0)
Dr Google wrote about EPE and biopsy: "Tumor admixed with periprostatic fat is the most easily recognized manifestation of extraprostatic extension. Tumor in fat is almost always a feature of extraprostatic extension by prostate cancer."
But it looks like that a biopsy as an unwanted rare SE also can cause EPE! However "seeding of prostate cancer along a needle biopsy track is a rare complication."
www.urologycasereports.com/article/S2214-4420(15)00012-1/fulltext. Have anyone heard about such a risk?
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