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Thread: What I Need to Know About About Prostate Biopsy

  1. #181

    Example of a Biopsy Report

    For those of you with your first biopsy scheduled, I've uploaded an example of an actual (positive) biopsy report (mine). The report itself is 4 pages, followed by a 4-page Patient Counseling Report. (The biopsy was done in my uro's office and the specimens were sent to a division of Labcorp for analysis.) I've redacted my personal health information (PHI), my doc's info, and the pathologist's name. My uro gave me a printout of this report at my first visit after his nurse's "Your biopsy came back positive for prostate cancer -- come in to discuss" telephone call.

    As my signature summarizes, I had 2 positive out of 14 total cores, one a G10 (5+5), the other a G9 (4+5). (At the visit where my doc felt a new nodule and said he wanted the the biopsy, I asked if we could add a couple extra to the 12 he planned.)


    Page 1

    Not sure if you can tell from the photomicrograph, but I wasn't smiling. I had to enlarge the page on my PC to see that the small G9 lesion (Right Lateral Middle zone) was indeed in red (malignant) in the figure. The width of the red is proportional to the percentage of the core length that was cancerous, just 3% in that core. I'm sorry that the uploaded images aren't sharper.

    Page 2

    Page 3

    Page 4

    Page 5 Start of Patient Counseling Report

    Continues next post -- there is a limit on image uploads of 5 per post.
    Attachments Pending Approval Attachments Pending Approval
    Last edited by DjinTonic; 07-26-2019 at 03:16 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  2. #182
    Here are the last 3 pages.

    Page 6

    Page 7

    Page 8
    Attachments Pending Approval Attachments Pending Approval
    Last edited by DjinTonic; 07-26-2019 at 03:20 PM.

  3. #183
    A review of optimal prostate biopsy: indications and techniques [2019, Review, Full Text]

    Abstract

    Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI–TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI–TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.
    From the Full Text:

    Conclusion

    Prostate biopsy remains the cornerstone of prostate cancer diagnosis and TRUS-guided biopsy is widely used in the diagnosis. Indications of prostate biopsy include gross DRE abnormality, PSA greater than 4 ng/ml in the high-risk age group, or lesions with PI-RADS2 score of 4 or 5 on mpMRI. PI-RADS 3 lesions have an equivocal cancer risk; decision to biopsy should be based on subjective evaluation by an expert uroradiologist or patient-specific factors. The application of mpMRI to the diagnosis of prostate cancer has the potential to revolutionize the current practice and emerging data highlight its potential use as a biopsy triage tool. MRI-fusion-guided prostate biopsy techniques have been shown to be superior to the historical standard of care TRUS biopsy as it is associated with high CDR, eliminating unnecessary systematic prostate biopsies for patients with elevated PSA levels, and repeated tumor-negative TRUS biopsy. There are several fusion software platforms each with demonstrated advantage in cancer detection compared with TRUS although no direct comparisons between platforms have been made. As more data emerges, consensus should be sought regarding the role of prebiopsy imaging in prostate cancer and how this effects patient selection for biopsy and intervention

  4. #184
    Experienced User wolfgang's Avatar
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    Some more about TRUS biopsies

    Quote Originally Posted by DjinTonic View Post
    A review of optimal prostate biopsy: indications and techniques [2019, Review, Full Text]From the Full Text:
    I wasted a few years trusting the TRUS biopsies thus giving my cancer to grow and get more aggressive. I had two false negative TRUS biopsies and said to myself: It's either this urologist doesn't know what he is doing or I don't have cancer. It turned out the first one to be true. While waiting for a third biopsy my PSA grew from 3.6 to 10.7 (LabCorp analysis). Fortunately I found out about a 3D Saturated Biopsy performed at the Colorado University Hospital and went there for a new type of Biopsy. This procedure is performed through the perineum so there was no colon perforating involved. The urologist made 52 needle samples through a pattern of 100 holes (how many samples depends on the prostate size) and finally the bad guy was exposed in 7 of 52 samples (one core G7 and one core G9). After the RP the new biopsy confirmed the G9 core while the G7 was downgraded to G6. Fortunately in 20 lymph nodes removed there were no signs of malignancy. That's my story regarding the biopsy, so your guide is the PSA, don't trust those who say, high PSA not necessary means PC. The old rule applies: If it walks like a duck and sounds like a duck then it is a duck! Regards.
    Last edited by wolfgang; 09-04-2019 at 08:17 PM.
    Age 63 in 2014
    10/2009 - PSA 3.6 Mild BPH symptoms
    04/2010 - PSA 4.5 First TRUS biopsy, negative
    10/2010 - PSA 5.6 Second TRUS biopsy, negative,
    12/2013 - PSA 10.7 Mild symptoms, no nocturia
    04/2014 - Saturated biopsy, 7/52 , Gleason 4+5
    05/2014 - Retropubic Radical Prostatectomy w/ Hernia repair
    Post-Op - Pathology negative, PCa Stage pT2b, N0, Mx
    06/2014 - Incontinence, ED still present
    06/2014 - PSA Total Ultra-sensitive <0.01
    07/2019 - PSA Total Ultra-sensitive <0.01

 

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