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Thread: Biopsy results

  1. #1

    Biopsy results

    Hello all,

    Just got my latest results (automated so no Dr interpretation) and it seems to be marginally worse than the results that first caught my PCa.

    Last year's results:

    1) PROSTATE, RIGHT APEX (BIOPSY): BENIGN PROSTATIC TISSUE.
    2) PROSTATE, RIGHT MID (BIOPSY): BENIGN PROSTATIC TISSUE.
    3) PROSTATE, RIGHT BASE (BIOPSY): BENIGN PROSTATIC TISSUE.
    4) PROSTATE, LEFT APEX (BIOPSY): BENIGN PROSTATIC TISSUE.
    5) PROSTATE, LEFT MID (BIOPSY): SMALL FOCUS OF PROSTATIC ADENOCARCINOMA,
    GLEASON SCORE 3+3=6 (GRADE GROUP 1), INVOLVING LESS THAN 5% OF ONE (1) CORE.
    6) PROSTATE, LEFT BASE (BIOPSY): BENIGN PROSTATIC TISSUE.

    Last weeks results:

    1.Prostate, Right base (RB) (Biopsy): Focal high-grade prostatic intraepithelial neoplasia.

    2.Prostate, Right mid (RM) (Biopsy): Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group 1) involving 10% of one (1) of two (2) cores. See Note.

    NOTE: Immunohistochemical staining for PTEN and ERG are pending on part 2 and will be reported separately in an addendum.

    3.Prostate, Right Apex (RA) (Biopsy): Benign fibromuscular tissue.

    4.Prostate, Left Base (LB) (Biopsy): Benign prostatic tissue.

    5.Prostate, Left mid (LM) (Biopsy): High-grade prostatic intraepithelial neoplasia.

    6.Prostate, Left apex (LA) (Biopsy): Prostate tissue with small focus of atypical glands, suspicious for low grade adenocarcinoma.


    Seems that the findings of High-grade PIN and the fact that last year was Left mid and this year it is right mid for G6 that the PCa is progressing? Does that seem correct to you guys? Its is a little frustrating to get these automated results on a Saturday....
    Age 59
    PSA 09/13 - 2.6
    PSA 05/18 – 4.7
    DRE 05/18 – Nothing of note
    MRI PROSTATE W/WO CONTRAST WITH 3D 06/18 – Assessment Low (clinically significant cancer is unlikely to be present)
    Biopsy 08/18 - SMALL FOCUS OF PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1), INVOLVING LESS THAN 5% OF ONE (1) CORE.
    08/18 - Joined Active Surveillance Program at JHH under Dr. Christian Pavlovich
    PHI 02/19 - PSA (Hybritech) 3.8 ng/ml, PSA % Free 5%, PHI - 31.0
    PSA 08/19 - 5.8
    Biopsy 10/19 - in

    Family history: Father diagnosed with PC at 61

  2. #2
    As you know, biopsies are hit or miss. I don't think you doc will be overly concerned. Do you know the details of your dad's PCa?

    Personally, I think that once you have PCa lesions, atypical findings elsewhete are not of great importance.

    Keep us posted,

    Djin
    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(5L, 11R): 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 retest)
    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

  3. #3
    Yep check my signature.....I had the same thing.

    March 08--all clean just like yours
    March 09--2mm g6 and one core of pre-cancer
    Sept 09--three areas of G6 with lots more found.

    I'm sure I'll develop a real hate club here but I think AS is snake oil. There just isn't imaging available to ensure they found it all for biopsy. You may be "watching" a small G6 while something serious is growing elsewhere.

    Best of luck to you.

  4. #4
    Quote Originally Posted by IceStationZebra View Post
    Yep check my signature.....I had the same thing.

    March 08--all clean just like yours
    March 09--2mm g6 and one core of pre-cancer
    Sept 09--three areas of G6 with lots more found.

    I'm sure I'll develop a real hate club here but I think AS is snake oil. There just isn't imaging available to ensure they found it all for biopsy. You may be "watching" a small G6 while something serious is growing elsewhere.

    Best of luck to you.
    No one will hate you, but AS programs are good at flagging the less than 50% of men when they do need treatment. The sometimes poor urinary and potency outcomes of primary treatment can be permanent.

    The anti-screening argument is that too many men are overtreated. The AS can be the middle ground -- a temporary or permanent holding pattern.

    Djin
    Last edited by DjinTonic; 10-26-2019 at 09:55 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(5L, 11R): 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 retest)
    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

  5. #5
    I’ll respect ISZ’s opinion given his frustrating experience in determining the extent of his disease. That said, AS is now the default recommended treatment for low risk men according to all the medical associations that issue guidance for the treatment of prostate cancer. It has allowed me to live normally and safely for ten years since diagnosis.

    Regarding your biopsies, that appears typical from my experience. When there are only small amounts of low risk PCa, the needles will often miss a lesion, yet find a different one. It is also not unusual to have negative biopsies after a positive one.

    Was there an MRI before this biopsy? Have/will there be genomics testing?

    That appears to be a low risk pathology. Relax, and discuss with your urologist.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  6. #6
    Thanks to all of you guys for taking the time to respond, very much appreciated. I totally get the nagging concern about existing with PCa on AS. It does feel like your gambling somewhat.
    Age 59
    PSA 09/13 - 2.6
    PSA 05/18 – 4.7
    DRE 05/18 – Nothing of note
    MRI PROSTATE W/WO CONTRAST WITH 3D 06/18 – Assessment Low (clinically significant cancer is unlikely to be present)
    Biopsy 08/18 - SMALL FOCUS OF PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1), INVOLVING LESS THAN 5% OF ONE (1) CORE.
    08/18 - Joined Active Surveillance Program at JHH under Dr. Christian Pavlovich
    PHI 02/19 - PSA (Hybritech) 3.8 ng/ml, PSA % Free 5%, PHI - 31.0
    PSA 08/19 - 5.8
    Biopsy 10/19 - in

    Family history: Father diagnosed with PC at 61

  7. #7
    There was no mri before this biopsy. I had one prior to last years and it didn't show anything. I will press the doc next week when we talk on that. No genomics yet but will also ask for it.
    Age 59
    PSA 09/13 - 2.6
    PSA 05/18 – 4.7
    DRE 05/18 – Nothing of note
    MRI PROSTATE W/WO CONTRAST WITH 3D 06/18 – Assessment Low (clinically significant cancer is unlikely to be present)
    Biopsy 08/18 - SMALL FOCUS OF PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1), INVOLVING LESS THAN 5% OF ONE (1) CORE.
    08/18 - Joined Active Surveillance Program at JHH under Dr. Christian Pavlovich
    PHI 02/19 - PSA (Hybritech) 3.8 ng/ml, PSA % Free 5%, PHI - 31.0
    PSA 08/19 - 5.8
    Biopsy 10/19 - in

    Family history: Father diagnosed with PC at 61

  8. #8
    Quote Originally Posted by working_man View Post
    Seems that the findings of High-grade PIN and the fact that last year was Left mid and this year it is right mid for G6 that the PCa is progressing? Does that seem correct to you guys? Its is a little frustrating to get these automated results on a Saturday....
    Small amount of Gleason 6 cancer, not much different from last year. You should definitely discuss this with your doctor, but it really doesn't seem that urgent action is needed. The fact that the doctor let the results go out automatically tells me that he doesn't think that urgent action is called for. Otherwise he would have held it back, and delivered the news personally I would think.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  9. #9
    Quote Originally Posted by DjinTonic View Post
    No one will hate you, but AS programs are good at flagging the less than 50% of men when they do need treatment. The sometimes poor urinary and potency outcomes of primary treatment can be permanent.

    The anti-screening argument is that too many men are overtreated. The AS can be the middle ground -- a temporary or permanent holding pattern.

    Djin
    I was being tongue in cheek re the hate club (forgot my smiley face).

    Maybe AS just didn't work out for me. But the cancer I just found was there when I had biopsy 1 and 2 were done. I hope and pray the post RP doesn't show worse. So my problem is just with the inability to say definitively what's there. Maybe I should lay off my AS bashing. Maybe those with a low psa that's stable and multiple biopsies showing isolates G6 makes sense.

    My last psa was 4.8 and has been steadily but consistently rising so maybe I wasn't a good AS candidate.

  10. #10
    Quote Originally Posted by IceStationZebra View Post
    I was being tongue in cheek re the hate club (forgot my smiley face).

    Maybe AS just didn't work out for me. But the cancer I just found was there when I had biopsy 1 and 2 were done. I hope and pray the post RP doesn't show worse. So my problem is just with the inability to say definitively what's there. Maybe I should lay off my AS bashing. Maybe those with a low psa that's stable and multiple biopsies showing isolates G6 makes sense.

    My last psa was 4.8 and has been steadily but consistently rising so maybe I wasn't a good AS candidate.
    AS stats give support to the theory that most PCa, perhaps including agressive cases, aren't that fast moving. Biopsies and imaging both miss existing cancer with false negatives, but the chances of repeated investigations continuing to miss it go down very fast. I don't know how long before detection my PCa started, but I'd say it was on the order of years rather than months. There are cases of metastatic PCa getting through AS programs, but the rate is very low. On the other hand, many men with low-risk PCa will die of other causes on AS, without unnecessary treatment and without the risk of poor treatment outcomes.

    Being on AS to find at some point treatment has become necessary does not mean AS was a failure, but rather that it was a very decent chance to win the first prize of avoiding treatment or the second prize, buying time to better treatments.

    As detection improves for both identifying cancer and for distinguishing risk categories, AS stats can only improve.

    Djin
    Last edited by DjinTonic; 10-27-2019 at 02:27 AM.
    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(5L, 11R): 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 retest)
    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

 

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