false positive biopsy report

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isidore
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/15/2010 12:25 PM (GMT -6)   
 
Last summer my urologist noticed a slight rise in my PSA score to 2.58.  He suggested either a biopsy or continued observation.  On January 6th my PSA score had risen to 3.54 and he suggested a biopsy.  On January 18th, I had the procedure with 12 core samples being taken.  4 days later I got the report back that I had prostate cancer.  The diagnosis read that 7 of the cores were benign.  But 1, the right medial base, and 9, the Left Medial Apex cores were
Atypical with Small Acinar Proliferation, (ASAP). 6, Right Lateral Apex, sample was Prostatic Adenocarcinoma, Gleason Grade 3+3, involving approximately 5% of the specimen.  8, Left Medial Mid-specimen, and 12, Left Lateral Apex specimen were Prostatic Adenocarinoma, Gleason grade 3+3, involving a focal area of the specimen.  With this information my urologist and I began to discuss treatment.  Radiation was the favored procedure and an appointment was set up with a radiologist.  On February 18th I received a call from the urologist telling me there were questions about the biopsy result.  It had been checked by three other pathologists including Jon Epstein and there was a question as to whether it was cancerous.  On February 25th I had another biopsy done with 18 cores taken.  On March 10th I got the results back and all the samples were benign.
I am very lucky to escape the discomfort and pain so many of you have gone through but isnt this unusual.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 5184
   Posted 3/15/2010 12:28 PM (GMT -6)   
This is indeed unusual, but nice!!
 
You might want to consider the PCA-3 test.
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2603
   Posted 3/15/2010 12:33 PM (GMT -6)   
We have men on here who had mutiple negative biopsies. John T is one of note. He had a color doppler which did find a transitional tumor as I recall.

There is an old saying that where there is smoke, there is fire.

We are all very happy for you, but I would personally advise that you keep a close eye on your PSA, and may even consider additional testing in the future.

You can be an associate member of HW. Thanks for letting us know !
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


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 2665
   Posted 3/15/2010 12:33 PM (GMT -6)   

I would HOPE this is unusual but it reinforces what many of us on this forum recommend, i.e. make sure a biopsy pathology report is read by one of the PCa pathology experts!  Unfortunately, we have had a case or two here where the post surgical pathology showed no cancer...you are very, very lucky to have discovered this before going thru a procedure.

Tudpock


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/15/2010 12:35 PM (GMT -6)   
isidore said...
 
...On February 18th I received a call from the urologist telling me there were questions about the biopsy result.  It had been checked by three other pathologists including Jon Epstein and there was a question as to whether it was cancerous...
You are correct that this is unusual, but not unheard of.  Your initial results generally said that you had a tiny, microscopic amount of cancer and some pre-cancerous signs.  Unfortunately, the interpretation of slides is not a "black or white" call; it is, as I indicated, subject to interpretation.
 
Curious...what were the conclusions of each of the "three other pathologists" who were consulted after your first biopsy?

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 3986
   Posted 3/15/2010 12:52 PM (GMT -6)   
The trouble with conflicting second opinions - you now need to get a third. Hope it comes out well.
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3667
   Posted 3/15/2010 1:24 PM (GMT -6)   
This is not unusal at all in fact it is more common that we all think. A study out of Boston that did a 3D mapping biopsy of men looking at focal treatments such as cryo or HIFU found 22% had no cancer. In many cases one or two cores and a small core % of G6 is nothing more than indolant cancer clusters that may never be seen again on a biopsy. To think that a lot of men with these stats went through pretty severe treatments for nothing is appaling.
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


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/15/2010 3:05 PM (GMT -6)   
John T said...
This is not unusal at all in fact it is more common that we all think. A study out of Boston that did a 3D mapping biopsy of men looking at focal treatments such as cryo or HIFU found 22% had no cancer. In many cases one or two cores and a small core % of G6 is nothing more than indolant cancer clusters that may never be seen again on a biopsy. To think that a lot of men with these stats went through pretty severe treatments for nothing is appaling.
JohnT

 
John, do you have a link to that study that you could post, please?
thanks in advance...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24044
   Posted 3/15/2010 3:49 PM (GMT -6)   
isidore, that is very fortunate at this point, been terrible to find that out after you went through radiation or surgery. another reason not to rush into a treatment when a biopsy shows a very minimal low volume PC dx. as you described.

since you were dealing with such a small amount of suspected cancer and since there is a subjective nature to reading the biopsy results, would have to say not a common event, but certainly not unheard of.

I too, would continue to keep an eye on things, and monitor closely in the future.

And please keep us posted.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3667
   Posted 3/15/2010 6:02 PM (GMT -6)   
Casey,
Origially posted on the New Prostate Cancer Info link.
The number was 20% not 22%

Onik et al. have now published data comparing the results of 3D-PMB with those from traditional TRUS-based biopsy data in 180 patients who had initially been diagnosed with unilateral cancer on TRUS biopsy. These patients were all considering some form of conservative management, and were restaged with 3D-PMB prior to making final treatment decisions. The 3D-PMB was carried out transperineally using a brachytherapy grid under TRUS guidance. Biopsies were taken every 5 mm throughout the volume of the prostate, and labeling of the specimen coordinates allowed accurate reconstruction of the location and extent of each patient’s cancer.

The results of this analysis were as follows:

3D-PMB was used to obtain a median of 50 cores (with a standard deviation of ± 20.61).
110/180 patients (61.1 percent) were shown to be positive bilaterally by 3D-PMB.
41/180 patients (22.7 patients) had their Gleason scores increased to ≥ 7.
36/180 patients (20 percent) had negative results on 3D-PMB.
Complications of 3D-PMB were self-limited (in other words, they resolved over time without specific intervention).
14/180 patients (7.7 percent) required short-term urinary drainage using an indwelling catheter.
2/180 patients (1.1 percent) had blood in his urine (hematuria), and one of them required overnight bladder irrigation.
This

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


isidore
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/16/2010 9:48 AM (GMT -6)   
Casey59 said...
isidore said...
 
...On February 18th I received a call from the urologist telling me there were questions about the biopsy result.  It had been checked by three other pathologists including Jon Epstein and there was a question as to whether it was cancerous...
You are correct that this is unusual, but not unheard of.  Your initial results generally said that you had a tiny, microscopic amount of cancer and some pre-cancerous signs.  Unfortunately, the interpretation of slides is not a "black or white" call; it is, as I indicated, subject to interpretation.
 
Curious...what were the conclusions of each of the "three other pathologists" who were consulted after your first biopsy?
As it was explained to me, after the original diagnosis of cancer, the slides were examined by a local review panel who described them as being "highly atypical" but not yet meeting the threshold of cancerous.  They were then sent to Jon Epstein and other pathologists who concurred with that diagnosis.  As I wrote before, the results  of a second biopsy done a month later, all 18 cores were benign.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24044
   Posted 3/16/2010 10:13 AM (GMT -6)   
Still an incredible situation, but definitely great news for the bearer. Will have to remember this case for a long time.
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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days

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