Biopsy Results Help

 

New to Board - Hello Everyone,

 

I would greatly appreciate any comments/insights to my recent biopsy results.  My PSA jumped from 3.9 to 4.5 in June 07 and my uro recommend having a biopsy.  Here is my situation.   I had a TRUS biopsy performed on June 15, 07 with the following results -

 

1 of 12 positive (with less than 1% of tissue). Right Base with no perineural invasion seen.

Stage T1c  Gleason 3+3=6

DRE Negative

PSA 4.5

Age 64

 

My uro indicated I was low risk and recommended robotic surgery.  Since there was only one core positive with less than 1% of the tissue involved, I decided on having a second opinion  and met with a another uro.  After reviewing the initial biopsy pathology report, the second uro wanted to send the path slides to Johns Hopkins for review.  The Johns Hopkins report came back stating the prostate tissue with a small focus of atypical glands is suspicious for carcinoma.  However due to atrophic features, a definitive diagnosis cannot be made.  Johns Hopkins recommended a repeat biopsy should be performed.  The Johns Hopkins report further stated that the pathology testing process in the initial biopsy is also found positive in the majority of high grade prostatic intraepithelial neoplasia and occasional benign glands of cancer.  Therefore, a positive P504S staining does not equate to prostate cancer. 

 

Per the JH recommendation, repeated the biopsy on Aug 23 07 by the second uro.  This time 16 samples were taken with a focus of 4 samples from the Right Base.  I received the results from the second biopsy on Aug 28th which stated all 16 core samples were negative with no tumor seen in any area of the prostate. 

 

Up until the second biopsy, I had been strongly considering surgery or proton treatments.  The second uro recommended coming back in Jan 2008 for a PSA test and decide what to do at that time depending on the PSA results.  I'm not one for WW and was wondering if anyone has had a similar experience with their biopsies.

 

Thanks for any comments or suggestions.

 

Jac

 

 

 

Hi There Jac,

I also sought out a second opinion following my biopsy becuase I had 1 of 10 core samples being positive. The slides from my biopsy read by the pathologist at the university medical center I went to for the second opinion indicated atypical instead of carcinoma. My urologist at the medical center said that contradicting slide reads occurs about 4% to 5% of the time as it is not all science. As he said you do not want to take out a healthy prostate. My slides were then sent to Dr. Jon Epstein at John Hopkins. My urologist said that in the hundreds of slides that were read by Dr. Epstein at this medical center and were read as carcinoma the post surgery path results comfirmed he was right every time. He read my slide as being carcinoma and the post op path report confirmed it. You should feel totaly comfortable that your slides have been evaluated by the best and the recommendation to follow up with a second biopsy in a few months sounds to be very prudent.

Tamu

Hi Jac,

Welcome to a great forum!  I'm glad you explained your condition so well and am sorry you have to go through this.  We're not professional cancer specialists in this forum, but we're here to help and discuss and to make you feel "at home."

From my recollection, your PSA is borderline for your age, but not alarming.  I am 54 and when I called my urologist's office with my PSA results of 4.3 received from my family doctor, the nurses at the urologist were not alarmed at first.  When they looked at my charts and saw that my PSA had jumped from 1.2 to 4.3 in a few months, they scheduled an appointment.   After an inconclusive DRE and some deep thought, my urologist decided to schedule a biopsy and we found some cancer.  Your change from 3.9 to 4.5 does not sound like a large "jump" to me.

You have been very wise about your approach, in getting second opinions and another biopsy.  Jan 2008 for the next biopsy is only four months away and I don't think you are in any danger from waiting.  For example, my urologist/surgeon said I could wait 4-6 months to do my surgery after cancer was positively identified and she wasn't worried about it spreading during the wait.

Please hang in here with us.  We'd like to follow your journey with you and you may be of help to others that join the forum with your similar diagnosis.

All the best,

Barry (a.k.a. Idaho)

Hi Jac,
You didn't state what size your prostate was. As men get older often the prostate enlarges and may have benign tissue that can cause a small rise in psa. Also, if your prostate is larger than normal, even 16 biopsies samples can miss a small tumor. It is wise to monitor your psa rise if any and maybe do a follow up biopsy in the near future. Also, don't be in a hurry to choose a treatment option as there are always side effects to all of them that you will have to live with the rest of your life. Also many of the treatment options haven't had any long term studies to show the effectiveness of them. So choose them at your own risk.

Ron