Improving Biopsy Protocol Article

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Tim G
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Date Joined Jul 2006
Total Posts : 2361
   Posted 10/24/2009 12:26 AM (GMT -6)   
Here is a link to a  MedWire piece about an article in the Journal of Urology.  It deals with improved biopsy protocols that help in the prostate cancer treatment decision-making process.
This article caught my eye because it quoted Jonathon Epstein from Johns Hopkins, a world-class expert on prostate biopsy interpretation.  He did a second opinion interpretaion of my own biopsy slides.
This may be of interest to some of you as it was to me.  

PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE negative  1 of 12 biopsies positive (< 5%) 
Open surgery June 2006 at age 57
Organ-confined to one small area, Gleason 5   
PSA's undetectable  < 0.1  

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 10/24/2009 12:19 PM (GMT -6)   
These guys are still missing it. This article is more detail on the Hopkins study of AS which concluded that low grade tumors rarely progress and progression in AS patients is due to mis sampling of high grade tumors in the initial biopsy. They recommend that 2nd biopsies sample the anterior as this is where most of the undetected tumors were located.
If all AS patients were given a color doppler ultrasound this would eliminate practically all of the transition zone tumors that were not found on the initial biopsy.
Initial biopsies rarely sample the transition zone and 20-25% of all tumors are found there.
Color Doppler Ultrasound biopsies are given by interventional radologists and urologists consider biopsies their territory and are very relunctant to refer patients outside the urological community for biopsies.
This is an example of where we have an excellent tool for PC detection that is not being used because of inter disiplainary rivilry, and it is hurting us patients.

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.


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