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MariaM
New User
Joined: 10 Aug 2008
Posts: 3
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 Posted: Sun Aug 10, 2008 1:54 pm Post subject: Repeat Biopsy |
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Hi,
I am looking for advice and hope that someone can provide the information/suggestions. My husband is 60 years old and he has been watching his PSA which has been slowly increasing for the last couple of years. The last PSA result about 3 weeks ago showed 3.3 compare to 2.1 in last November. The urologist recommended biopsy and my husband agreed to do that.
The biopsy revealed that out 6 specimens, one showed ‘small atypical glands 1mm, suspicious for carcinoma’ and strongly suggested malignancy. The doctor is recommending 2nd biopsy in 6 weeks, targeting specific area. We are not sure if we need to do 2nd biopsy or go for the 2nd opinion to a different doctor. I would very appreciative your input and recommendations.
Thank you very much, |
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brainman
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Joined: 13 Oct 2005
Posts: 4440
Location: Tennessee
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johnw100
Senior User
Joined: 15 Apr 2006
Posts: 155
Location: australia
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| Posted: Sun Aug 10, 2008 5:57 pm Post subject: Re: Repeat Biopsy |
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If you havn't already done so, it's a good idea to obtain a full print out of the biopsy report, to make it easier to refer to details and refer to it for future reference.
Also obtain details of prostate size which has an influence on PSA readings: an enlarged prostate produces more PSA which usually accounts for the slow increase you mentioned.
As you might know it's the change in PSA readings which is more important than any individual reading: one definition of rising PSA is 3 higher peaks, (not necessarily on consecutive readings). Individual readings can vary for a variety of reasons including inflamation, DRE just before the blood test, or sometimes for no known reason.
The relatively large recent rise is something to watch closely: you could monitor this carefully on a more regular basis.
If it continues to rise, you could also include a "freePSA" reading which indicates the % of PSA from benign causes and is a guide to the probability of PC.
Usually 12 biopsy samples are taken ??
With fewer samples, there is more potential to miss a small tumor.
Biopsy readings are subjective, so it's best to obtain a 2nd opinion from an expert pathologist. Slides could be sent to Johns Hopkins for example.
See what a 2nd reading comes back with, but in any event, if more regular tests confirm a rising PSA, I would agree with the suggestion of another biopsy, especially if the first only had 6 samples.
Best wishes,
John |
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MariaM
New User
Joined: 10 Aug 2008
Posts: 3
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| Posted: Sun Aug 10, 2008 6:31 pm Post subject: Repeat Biopsy |
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Thank you very much for a quick reply. This is extremely helpful information. I am not sure why the biopsy was done only on 6 samples. We will make sure that if we do a repeat biopsy, it is actually using 12 samples.
Some 12 years ago my 67 year old father was diagnosed with prostate cancer. At that time I did a lot of research and we have selected a seeds implant method. We went to Seattle and had the procedure done there. My dad has been doing really well, his PSA is0.1. We worked with Doctor Schulz, LA area oncologist. We will probably go back to him for the 2nd opinion for my husband, since I am don’t have recommendations for any other oncologist/urologist. I wander if is there anyone on the board from LA/Orange County area who can provide recommendation for the good doctors in the area.
Thank you, |
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Beth56
Regular
Joined: 30 Mar 2008
Posts: 30
Location: California
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| Posted: Sun Aug 10, 2008 8:53 pm Post subject: Re: Repeat Biopsy |
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We have a friend who had 2 or 3 biopsies before the cancer was found. It's a hit or miss situation. So I would also recommend another biopsy of 12 samples.
My husband was 62 when his PC was discovered 2 years ago. He had Proton Beam Therapy at Loma Linda Hospital. We have been very pleased with the results so far.
You mentioned Seattle for seed implants. I believe there is a hospital in that area that is very well-known for seed implants. The name escapes me at the moment, but perhaps that is where your father was treated. I am pleased he is doing so well.
You and your husband have my best wishes. |
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MariaM
New User
Joined: 10 Aug 2008
Posts: 3
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| Posted: Sun Aug 10, 2008 9:12 pm Post subject: repeat biopsy |
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Beth,
Thank you very much for the reply. Yes - I went with my dad to the hospital in Seattle that pioneered the seed implant method at the time. We also went then to Loma Linda, but proton beam therapy was in the very initial stages 12 years ago and did not have sufficient follow-up study. So we chosen seed implement procedure for my dad. A lot of things changed since then and more information now is available. Unfortunately I have to start all over again now with my husband. At this point I am trying to a find a right doctor who can do the best for us in terms of diagnosis so we can make informed treatment decision if the 2nd biopsy confirms the tumor.
I am very glad that your husband is doing well. From what I know, Loma Linda is an excellent facility with very good doctors. I was very impressed with them even 12 years ago.
Sincerely,
Maria. |
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Beth56
Regular
Joined: 30 Mar 2008
Posts: 30
Location: California
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| Posted: Sun Aug 10, 2008 9:24 pm Post subject: Re: Repeat Biopsy |
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I can't give enough praise for Loma Linda Medical Center. Everyone from the doctors, nurses, staff, etc. was so organized and caring it was unbelievable. Our experience there was A+ and I would never hesitate to recommend it to anyone for any cancer treatment.
If I can offer anything to you regarding our experience or the treatment, please let me know. I would be happy to share. I do realize that everyone has their own paths to follow regarding treatment, so I won't give you the sales pitch.  But I will say, we are so very happy with our choice.
Please let us know about your husband. There are lot's of good people here with sound advice. Take care. Beth |
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Otago
Regular
Joined: 20 Jan 2008
Posts: 28
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| Posted: Mon Aug 11, 2008 9:34 pm Post subject: Re: Repeat Biopsy |
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[quote="MariaM"]Hi,
I am looking for advice and hope that someone can provide the information/suggestions. My husband is 60 years old and he has been watching his PSA which has been slowly increasing for the last couple of years. The last PSA result about 3 weeks ago showed 3.3 compare to 2.1 in last November. The urologist recommended biopsy and my husband agreed to do that.
The biopsy revealed that out 6 specimens, one showed ‘small atypical glands 1mm, suspicious for carcinoma’ and strongly suggested malignancy. The doctor is recommending 2nd biopsy in 6 weeks, targeting specific area. We are not sure if we need to do 2nd biopsy or go for the 2nd opinion to a different doctor.[/quote]
Well, you know if you search, search, search, in a 60 year old man, any 60 year old man, you are very likely to end up finding something that qualifies as "cancer". His PSA is still not "high"........although the last particular test did have a 1.2 rise. I just might note, my last test dropped 1.2 points after one unusual rise and then stayed at the prior low level area. Had I gone looking for PCa without waiting to see what another PSA test might reveal, I could be right where you are.
I think there is a considerable segment of science behind not finding all early prostate cancer. As odd as it sounds, eventually when we have better diagnostic tests, we probably won't want to treat all the PCa we find. Currently we often can't tell which prostate cancers are the bad ones and which are the ones to leave alone. .......That, even between two Gleason 6 readings.
From your description it sounds like the last biopsy may have found some PIN.
Let me make it clear, I'm not a advocate for doing one thing or the other, but I just wanted to say that other than that one rise in his PSA, it would seem that nothing is unusual prior to the "unusual" biopsy report.
Get second and if wanted third opinions...and also estimate your ability to live with risks going into the future. Some with low grade Gleason 6 prostate cancer want it out ASAP... Some others beginning in your husband's age range, might wait and see how it goes and how the next PSA test goes.
Here is a study that I only recently read about. It make for a interesting take on the subject of lower level PSA low level cancers, Gleason 6....
http://prostatecancerinfolink.net/2008/06/27/active-surveillance-the-ucsf-contemporary-cohort/
Just offering another avenue........but of course, we don't know what the next biopsy will reveal.
Otago |
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