24 sample biopsy

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Regular Member

Date Joined Jul 2009
Total Posts : 27
   Posted 7/18/2009 11:01 AM (GMT -6)   
Hi all,
I'm newly Dx 3+3, Stage T2a, DRE: pos, still trying to decide on treatment. Second opinion from a urologist said wait for 6 months and get another biopsy. This time with 24 samples.
Has anyone ever had a 24 sample biopsy? Seems like it would destroy the prostate. He said it might be difficult to save the nerves because of scar tissue  from the biopsy.
He also said he wanted to wait because sometimes after surgery the biopsy shows that waiting would have been the best thing to do.
I'm confused. confused
Any comments would be greatly appreciated.

Age: 64
Dx: 6/2/09, Age 63
G: 3+3
PSA: 2.04
Samples: 12, 1PC, 20%
Stage: t2a
Still trying to decide on treatment.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 7/18/2009 12:30 PM (GMT -6)   
we have had members here with saturation biopsies. As many as 40 that I can recall. Usually they are performed when regular biopsies are negative but PSA keeps rising. The prostate will heal, but it may be a moot point if the cancer is serious enough to remove it. Strangely, you have a very low PSA and a moderate cancer. It is a bit unusual for such an aggressive biopsy in such cases, but they found the cancer. Curiousity asks how many of those 24 cores were positive? Am I reading this wrong and you have not had the 24 core biopsy yet?

 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
My Journal is at Tony's Blog  

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 7/18/2009 1:45 PM (GMT -6)   
Tony , he had the first biopsy, 12 points, 1 positive, 20% PCa. 
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Forum Moderator

Date Joined Sep 2008
Total Posts : 4231
   Posted 7/18/2009 2:00 PM (GMT -6)   
Dear Huey:
Except for the DRE finding, you meet the requirements for "Active Surveillance" (aka Watchful Waiting) as listed by Johns Hopkins (see below):

1.  Age 60+.

2.  T1C, i.e. nothing felt on DRE.

3.  PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshhold.

4.  Gleason 6 or less.

5.  2 or fewer cores of cancer.

6.  No core with more than 50% cancer involvment.

I have never heard of a multi-core biopsy causing damage that would prevent nerve sparing.  I suggest you consult with another urologist BEFORE allowing this biopsy...you don't want to do anything to preclude never sparing.

Also, since you indicated you are looking at options, you might want to refer to a fairly lengthy post I just put on another thread..."prostate cancer treatment successes".  Maybe you will find this helpful.


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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Regular Member

Date Joined Mar 2006
Total Posts : 31
   Posted 7/18/2009 3:38 PM (GMT -6)   

Just curious; is your present health insurance hunky-dory or would Medicare be a better player in that department next year?


Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 7/19/2009 12:04 AM (GMT -6)   
Hi Huey,
We're close neighbors! Where are you having the treatment if/when you decide? Looks like you have plenty of time to work through the decision making process.

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4840
   Posted 7/19/2009 6:00 AM (GMT -6)   

Can't say that I've understood why one would do "watchful waiting" when you've been dianosed to have prostate cancer?

What does a person wait for?


Age 54   - 5'11"   205lbs
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
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 7/19/2009 9:26 AM (GMT -6)   
We always welcome newcomers by telling them that this is a club that we never want anyone else to join. Your case is odd. I am NOT a doctor. But. I have read of many members’ journeys. Given your PSA and biopsy the idea of a more aggressive biopsy is very uncommon. Perhaps there is something else about your condition that your doctor did not communicate.
One of the ongoing themes here is get a second opinion (or more). No good doctor will be put off by your seeking more advice. Your medical records belong to you and your current doctor will send your biopsy slides to another doctor of your choice. Because your situation is so atypical compared to other members’ I would urge further opinions in the strongest possible terms.
You might want to read about the use of color doppler as a diagnostic tool and consult with a doctor as to whether this would be appropriate in your case. Both biopsy and color doppler have their limitations and so for some patients the combination makes sense.

As to watchful waiting – some prostate cancers are very slow growing. So much so that they will never cause you any trouble for the rest of your life. There is considerable current medical opinion that our increased ability to detect PC may now lead to treating such cancers and thus expose patients to not insignificant side effects. It is accepted medical treatment to simply observe such cancers under the supervision of a doctor who specializes in such treatment.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0

Forum Moderator

Date Joined Sep 2008
Total Posts : 4231
   Posted 7/19/2009 10:53 AM (GMT -6)   
Since you asked about watchful waiting, here is a link to the Johns Hopkins program. 
I can easily understand why an older male whose cancer might not ever threaten his life, would opt to "wait" to see if treatment was required.  No procedure....no side effects.  However, I think a patient's psychological makeup is critical.  Some men can't stand the stress of having the cancer in their bodies, however small or indolent.  But, for those who can and who have the discipline to follow up properly, this can be a great choice.
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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4245
   Posted 7/19/2009 8:35 PM (GMT -6)   
Rather than a 24 core biopsy get a color doppler targeted biopsy. It is more accurate and rarely more than 6 cores will be taken and only of suspicious areas. There are many benefits over a regular biopsy: It can identify all agressive cancers (I had a 26 core that missed a large tumor). It can be used as a baseline for Active Survielance, eliminating other biopsies. It can accurately identify the size and location of any tumor that is found. It is also less painful.
I woud travel to Fred Lee or Duke Bahn to have a color doppler; don't get one from a normal urologist, but from an interventional radiologist.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path 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. G 4+3 approx 2.5cm diameter.

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.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July


Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 7/19/2009 11:52 PM (GMT -6)   
Hi Huey, one of my urologists told me about a 3 plus 3, "you might die of that cancer, but you're really going to have to work at it, and be willing to devote the next 40 years to the quest."

I say one of my urologists, as I met with four, talked to three/four others, and a doctor (GP) friend consulted with about five more on my behalf. Each had their own take, their own perspective.

One thing I came to understand was that a month or two here or there while I decided what treatment to get (I had a second slide read --- that's another two doctors --- which put me at a Gleason 7) wasn't critical. As one urologist said, "You've got a long time ahead of you when this cancer is curable."

If you're a 3 plus 3 you're in even less of a rush than I was.

I can't help you with your question, lots of guys here are far better informed than I, but I think all would agree that you have time and you have more to lose rushing to a treatment than you do in taking some time to learn everything you can about your particular PCa and all the treatment options available.

If my second biopsy reading had agreed I was a 3 plus 3 I'd likely have had Bill Orovan in Toronto destroy the prostate with HIFU, which I thought of as watchful waiting with the kicker of a treatment that may well be as good as surgery but done on an outpatient basis. I'm told (by two U.S. doctors) that in the U.S. doctors with huge cash and training investments in other therapies have been slow to pick up on HIFU. They also told me (their words, not mine) that the FDA with American blinkers to the rest of the world, refuses to accept studies from places like France and Germany on HIFU and so it isn't approved in the U.S. Americans think of it as experimental. In Europe, Japan, Russia, it's an accepted therapy and the results from the third generation machines seem to be producing excellent results on a par or better, with surgery. HIFU has been approved in Canada for a number of years (Orovan has done some 400 treatments, many on Americans) and there are several centers here doing it. The two issues you'll need to satisfy yourself on are: 1) will the 3 to 10 year numbers for HIFU continue to track with surgery as time goes by? and 2) can you live happily without pathology? From my research I was satisfied that HIFU results would continue to track with surgical results ---- and, don't forget, both surgery and HIFU select only patients who are likely to benefit so going into either, if you're approved, you have good Karma. What tipped the scales for me was the possibility of being a Gleason 7 and not having the pathology to know for sure. After much introspection I decided I just wouldn't be happy without the pathology. At Gleason 6 I'd have been okay. If I was a Gleason 7 I wanted to know more. And so, I had daVinci surgery, last week got my pathology, and am now a little less sleepless than I was.

There are also other therapies such as freezing and the seeds you should look into, and perhaps radiation too. I only write about HIFU as it was the non-surgical therapy I had settled on. I liked it because all of the other options, including daVinci surgery, are still open if it doesn't work out. Including a second HIFU treatment. This isn't necessarily true, best I could tell, with other therapies. (One daVinci surgeon I talked to, in Cincinatti, has successfully removed a HIFUed prostate.)

Huey, you probably want to do a crash course on PCa about as much as you want to be told the pilot of your plane has died and the other passengers have elected you to land it. The good news is that once you get in the cockpit you find from ground control the plane has autopilot and they can talk you through the levers and switches you need to throw to bring it in safely. In six/eight weeks you'll find your PCa has consumed and taken over your life as you reseach and learn, but like a plane with autopilot you'll find choosing the right treatment, in the right place, at the right time, is a lot easier than it looked when you first started, and you'll come to understand you've got a long life ahead of you.

The daVinci surgeon in Cincinatti told me the five year survival rate for all PCa cases in Ohio was 100% --- and that includes the very worst of cases. Folks with numbers like yours, or even mine, should probably be more worried about getting killed in a car accident than dying of PCa. Which, of course, is easier said than done.

I'll look forward to hearing more from you.

And, like the other have said, sorry to see you've joined our club.

Sleepless AKA Sheldon
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  

Regular Member

Date Joined Jul 2009
Total Posts : 27
   Posted 7/20/2009 9:49 AM (GMT -6)   
Thanks to all for your responce. I value your information.
My urologist wants me to wait for 6 months and then get a 24 core biopsy.
Tuddock 18, thanks for the info.
Fogball, insurance is good until age 65.
swimom, I will probalbly go to Henry Ford Hospital, Dr. Mani Menon,
Geezer 99, good info, thanks
sleepless09, thanks for your personal info, well put.
John T, the color doppler sounds like a good idea in my case
thanks to all and good luck
Age: 64
Dx: 6/2/09, Age 63
G: 3+3
PSA: 2.04
Samples: 12, 1PC, 20%
Stage: t2a
Still trying to decide on treatment.

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