High-Grade PIN experiences

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scully66
New Member


Date Joined Jan 2010
Total Posts : 8
   Posted 2/17/2010 4:21 PM (GMT -6)   
Ah the wonderful rollercoaster world of PC...
 
As my sig shows, I'm 43 and HAD been diagnosed with early PC in January. Then, the second pathology report came back today from J Hops and showed, in their opinion, no signs of actual malignancy but instead some "atypical glands" next to High-Grade PIN. A second biopsy is now scheduled for next month along with new psa evals.  
 
Now, I'm just beginning my research on PIN and what excatly that means (in truth, it means you're closer to cancer than not, but you don't actaully have the big C yet).
 
I'm wondering if anyone has had a similar experience or, at least, was diagnosed with HG PIN during an initial biopsy and what that meant for you. Questions like:
 
What is your understanding of the meaning of PIN in relation to long-term prostate health?
 
At what point in time after PIN detection did cancer appear, if ever? Months? Years? Never?
 
Did you have annual or even bi-annual biopsies going forward?
 
Did you make - or learn about - any dietary changes to help stave off the evolution of PIN to PC?
 
In the grand scheme, if my second biopsy shows no PC but HG PIN, is that a reason to celebrate or just means delaying the inevitable?
 
 
 

Scott
43 years old
Diagnosed 1-21-10 with T2a, cancer found in 1 of 12 cores. Gleason 3+3.
psa 3.7 at diagnosis. 1.5 3 months prior
Second pathology done 2-17-10 shows Hi-Grade PIN instead of cancer
Biopsy re-do set for 3-16-10


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 2/17/2010 5:24 PM (GMT -6)   
Good question.

My first biopsy came back no cancer, but showed lots of PIN.

A year later, 2nd biopsy came back, no cancer, but showed lots of HGPIN (High Grade Pin) and my uro noted some shadows in the scan on the left side of the prostate.

6 weeks later, 3rd biopsy done, targeted 7 cores into the "shadows", found high % PC in all 7 cores, and lots of HGPIN as well.

When I asked a similar question to both my urologist and radiation oncologist, they both agreed that the prescence of HGPIN can be a pre-cursor to turning into cancer. No way to put an accurate time line on its conversion, and no guarantee that it will. But they said it typically does turn cancerous given enough time.

In my case, I believe that my 2nd biopsy just happened to miss the cancerous area, and my urologist had the good sense to go back as soon as it was safe to investigate the shadows. My desire at the time was to wait a whole nother year and then do the 3rd biopsy. I am glad to this day that I listened to my doctor's hunch and advice, as I am a Gleason 7 case. Hate to think what another year of waiting would have done.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3129
   Posted 2/17/2010 5:51 PM (GMT -6)   
Better keep an eye on this, HG PIN is more significant than just having PIN. Here is what this article says about it:
(I did a google search, so you can do the same to read more)
=============================================================
Suspicious results -

Sometimes when the pathologist looks at the prostate cells under the microscope, they don't look cancerous, but they're not quite normal, either. These results are often reported as suspicious. They generally fall into 2 categories -- either prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP).

In PIN, there are changes in how the prostate cells look under the microscope, but the abnormal cells don't look like they've grown into other parts of the prostate (like cancer cells would). PIN is often divided into low-grade and-high grade. Many men begin to develop low-grade PIN at an early age but do not necessarily develop prostate cancer. The importance of low-grade PIN in relation to prostate cancer is still unclear.

If high-grade PIN is found on a biopsy, there is about a 20% to 30% chance that cancer may already be present somewhere else in the prostate gland. This is why doctors often watch men with high-grade PIN carefully and may advise a repeat prostate biopsy, especially if the original biopsy did not take samples from all parts of the prostate.

Another finding that is sometimes reported on a prostate biopsy is atypical small acinar proliferation (ASAP), which is sometimes just called atypia. In ASAP, the cells look like they might be cancerous when viewed under the microscope, but there are too few of them to be sure. If ASAP is found, there's about a 40% to 50% chance that cancer is also present in the prostate, which is why many doctors recommend getting a repeat biopsy within a few months.

Last Medical Review: 07/30/2009
Last Revised: 07/30/2009
============================================================

Not meant to disturb you but for information sake, not all PCa's react similarily, there are around 14 variant types of PCa, then added differences within those including DNA-ploidity on the cell structures....it is complicated and should never be over simplified based upon what is known and proveable at this time in history. See pathology information websites from some of the few experts and learn alot more than you wish to know.













.
Youth is wasted on the Young-(W.C. Fields)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2589
   Posted 2/17/2010 6:43 PM (GMT -6)   
In one year my HPINS, went to Gleason 9 adenocarcinoma.

I really though it was kind of medical hystereia to tell me I had pre-cancerous cells. I would retort, isn't every cell pre-cancerous before it becomes cancerous.

Sound like you URO is right on top of it, but I agree, watch them carefully .

Goodluck !
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3620
   Posted 2/19/2010 7:38 PM (GMT -6)   
Scott,
Drs Strum, Scholz and Tisman did a paper on PIN a few years ago:
PIN has three grades, 1, 2, and 3,; High grade PIN is 2 and 3.
HGPIN is a precurser to PC by about 5 years.
Anyone who has HGPIN should be considered to have occult PC unless proven otherwise.
Quarterly PSA tests and annual biopsies are recommended.
Basically you should go on the same program that anyone doing Active Surveillance would do.
I have the paper in hard copy and if you email me your address I'll make a copy and send it to you.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 2/20/2010 10:32 AM (GMT -6)   
I had high grade PIN on my first biopsy and atypical cells. I was retested 6 months later and was diagnosed with PC gleason 3+3. By reading my stats, the rest was history. Fortunately I had a favorable outcome. The biopsy doc told me that PIN was quite common. I would'nt worry too much now. Wait and see the results of your next PSA.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00


porg
New Member


Date Joined Aug 2012
Total Posts : 1
   Posted 8/15/2012 3:01 PM (GMT -6)   
I had a rising PSA which went to 6.8 two years ago. Had three biopsies, the last one a saturation biopsy. Each one showed ASAP. The urologist said the chances of me having cancer were small but that the PC could have been missed. Now my PSA is 10.6. The velocity is concerning. Any thoughts on yet another biopsy? I understand that after three biopsies the chances of having PC are slim but my rising PSA is a concern.
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