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Thread: Prostate Cancer Diagnosis - For Sure or Money for Profit

  1. #1
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    Prostate Cancer Diagnosis - For Sure or Money for Profit

    I visited a urologist non-cancer condition of my urinary tract.
    During the referral for the urinary condition, the urologist performed an anal prostate exam. He thought my prostate was enlarged and too firm. My PSA is 2.5 and has never measured higher. He referred me to have a prostate biopsy.
    My Gleason results were 6s and 7s in 6 of 8 areas, percentage of cancer present varied from 5% to 15%. I am in good health. I have no history of cancer from either parents. I have none of the symptoms, only a dull ache in my prostate area and a reduce ejaculation output. Urine flow is good. I changed urologists for the prostate cancer treatment. Per the CT scan, my cancer has not metastasized. The 2nd urologist recomended external radiation and brachy therapy 2nd. I discussed my doubt with the radiologist and was considering a 2nd biopsy. He said "what if they miss detecting the prostate cancer?". I thought, what if they prove I donot have it? I have good insurance. I have read where Medicare is reducing payments for Prostate Cancer treatment. The oncology finance person told me that they were glad to have me for a patient due my full paying insurance. I wonder could this skew the radiologist decision to do the treatment for the money, not just the prostate cancer? I am afraid to ask around about this for fear of being black balled by the medical industry. Bottom line: how can you be sure you have prostate cancer without getting a 2nd biopsy? This have been other inconsistencies in this process.

  2. #2
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    I am new to this too. I am 53, have a psa of .78, gleason 6, and a tiny bump on my prosate they believe is a calcification but nobody is pursuing that right now. I had a biopsy and 9 of 10 samples were fine and 1 had less than 5% cancer cells. A prostatectomy is the recommendation because of my age. Anyway, you can certainly get a second opinion without having to go through another biopsy. Your biopsy slides can be sent to another lab and reviewed again if you have any doubts. I considered doing this. It is after all just a little cancer and the "racket factor" crossed my mind. I decided against it. But that doesn't mean you shouldn't have as many labs review your slides as you want or you or your insurace company are willing to pay for. Bostwick Laboratories was recommended to me. Good luck!

  3. #3
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    Hi Microwave, - If you really feel that your present care providers would "fake" a positive Pathology Report to obtain a procedure reimbursement, you better change to someone in whom you can place some trust.

    I suggest you acquire a copy of the Biopsy's Pathology Report, which identifies the Prostate Cancer (PCa) as being present. It should contain the details as to what was found on direct examination of the tissue samples, under the microscope. This examination is done by a Pathologist (MD), who is totally independent from the Urologist who performed the Biopsy itself, and is paid the same whether the findings are "positive" (PCa found) or "negative" (no Cancer observed). Although the assignment of a Gleason Score is a subjective judgment, it is done by a highly trained specialist and the identification of PCa is correct at 98% off the time. With 6 out of 8 cores containing malignant cells, you should feel confident in the fact that you do have PCa. The REAL question is always, "do the Biopsy SAMPLES accurately represent the true status of all the disease present in the TOTAL Prostate? There is usually no way to be positive!

    My suggestion would be to have the slides from the Biopsy sent to a recognized expert in the examination of Prostate tissue for a second opinion. Dr. Epstein at Johns Hopkins or Dr. Bostwick of Bostwick Laboratories are two that immediately come to mind, but there are others.. Verification of the present findings should satisfy any doubt, without the necessity of another Biopsy. The proliferation in numerous samples would imply more than one tumor and PCa is multi-focal (more than a single tumor) 70% of the time and so this is not unusual.

    I don't know why you think fraudulent activity would be present, but I would suggest that you find someone in whom you can feel confident or the important Doctor/Patient relationship is on shaky ground from the outset and, frankly, with your present, seemingly unjustified suspicions, I would be reluctant to accept you as a patient. What are the other "inconsistencies" that you mention, you have observed? Good luck! - John@newPCa.org (aka) az4peaks

  4. #4
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    Quote Originally Posted by mikerowave View Post
    I am in good health. I have no history of cancer from either parents. I have none of the symptoms, only a dull ache in my prostate area and a reduce ejaculation output. Urine flow is good.
    I know you are reluctant to join our club, we are all reluctant members.

    IMHO, your suspicion is not justified. Your urologist could very well save your life. The biopsy found 6 of 8 samples positive indicating your cancer is quite extensive. If you have doubt, you can send the biopsy to a reputable lab like Johns Hopkins for a second look but I doubt they will find a negative outcome. So, in my opinion, a second biopsy is not needed.

    By the way, "a dull ache in my prostate area and a reduce ejaculation output" are both symptoms of prostate cancer since you do not have an enlarge prostate or infection. I had dull ache and it went away after surgery.

    In general, a negative biopsy does not indicate no cancer since the needles only sample a small percentages of your prostate. However, a positive biopsy is a definitive diagnosis and the only argument there is usually the Gleason scores and the prostate cancer type.

    Early detection and treatment are the best defenses against prostate cancer. If you read many posts here, you will find that those who found their cancer after significant symptoms had a much harder time. So, if you don't have significant symptoms, count your blessing.

    We are happy to share our experiences with you, answer your questions the best we can and help you deal with your condition but you (with helps from your doctors) are the one who has to decide your course of action.

    Good luck and best wishes.
    PCa Dx at 65. PSA 2.5 in 2000, 8.4 in 6/09. Three negative biopsies in between. 6/10 PSA 10.7, biopsy 1 of 12 cores 5% cancer, Gleason 3+3
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4+
    9/10, 12/10, 3/11, 6/11, 6/12, 6/13, 12/13 PSA <.1

  5. #5
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    Hey MW

    Sorry you're here, but the odds of the diagnosis and/or biopsy results being faked are very, very, very slim.
    Getting a second opinion on your slides, not a repeat biopsy, never hurts, and may reassure you a bit.
    The scoring sometimes goes down on a second read, but (sorry) more often goes up - about 33% up to 5% down by Hopkins and other studies.
    The 6's are not good, but the scores to be properly concerned about are the 7's.
    With a Gleason 6 and 5% involvements, you could at least consider Active Surveillance. The grade 4 cells in your Gleason 7 mean you have aggressive tumor cells that need to be removed or killed off.

    BTW, typical symptoms are bad numbers on a piece of paper, physical symptoms like yours are unusual, and can signal more advanced disease

    I wish I had happier news, but the best I can deliver is a reality check

    Good luck
    age 60
    PSA 7.5
    Gleason 3+4
    HIFU June 10 Bermuda Dr Scionti
    Salvage HIFU April 11 Bermuda

  6. #6
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    Mikerowave, they wrote a book just for you! "Invasion Of the Prostate Snatchers" by Blum / Schulz...It will reinforce all your notions about a vast prostate cancer conspiracy aimed right at your wallet..

    You have Gleason 7 prostate cancer. Come to terms with that.. Be thankful that they found it so early (PSA 2.5) and a complete cure is a high probability..The IGRT + seeds is a very effective treatment..Be thankful it's available to you..Yes, there is a lot of money on the line here and yes the doctors will compete against each other for that money..But don't lose site that your life is on the line too..

    After you read Blum's book, read the one by Dr. Patrick Walsh, "Guide to Surviving prostate cancer" Then think it over and make a treatment decision...

    best of luck to you..
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14

  7. #7
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    MW, you look significant enough to get treatment. Get second opinions on everything; surgery, radiation, brachytherapy (both permanent seeds and HDR), and the biopsy.

    Tom, you should shoot the doctor that says to operate. You look very likely to do well with a good active surveilance program. If you want treatment then radiation will be far less damaging than surgery. Again, get second opinions on everything before doing anything.

    As far as rackets go, I am with Snuffy Myers when he says that low PSA, G6, and very little cancer should not be driven to surgery as their cancer is unlikely to be a problem.

 
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