So which biopsy report do I believe?

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 1/10/2010 3:39 PM (GMT -6)   
If you check my signature, you'll see that I had my biopsy at Umich. The slides were then sent to Ford Hospital and reread.
 
The second reading was much better than the first (3+4 vs. 4+3). Needless to say, I've kind of been going with the second reading.
 
Now, the original report was sent to Ford. I wonder if they examine that original or just completely do their own, letting the chips fall where they may.
 
Of course, all of this is academic/moot since I have surgery in 2 weeks and will get the more accurate path report a week after that.
 
But, still, I wonder...
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 1/10/2010 3:48 PM (GMT -6)   
Mel.......I think you're right about it being moot; especially with the two findings. If the second had shown a radically different Gleason, one way or the other, it might give you pause for treatment, maybe not. I think that what matters is what you get on the surgical path report. I had my biopsy done and read locally, and then had my slides sent to Hopkins where I believe Epstein read them. Both came back as a Gleason 6; with the difference being the volume % in certain cores, which differed only slightly (even the number of cores remained the same-4)
But my Gleason was upgraded to G-7 (3+4) after the surgical path read at HUP. IMO, you should continue on the path on which you have decided, treatment-wise....and best wishes!
 
Arnie in DE
 
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, NO MX, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/10/2010 7:48 PM (GMT -6)   
Hey Mel I suggested and emphatically (for your own peace of mind) for you to go to Bostwick first, of course I am an a dumb___ck of course.   LOL   
 
Now remember I mentioned Jungle, twilight zone, limbo land after treatments???  Maybe you will find these things truer than you imagined!  It is complicated and the experts are not experts (atleast not enough so).
 
Hope surgery goes well and it should with what you have lined up.
Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 1/10/2010 5:55:00 PM (GMT-7)


compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 1/10/2010 9:25 PM (GMT -6)   
Zufus:
 
I certainly did note your suggestion. However, Dr. Menon's team did need to see and evaluate the slides. So, it had to go there first.
 
At this juncture, there really is absolutely no point in getting that third opinion. It certainly is not going to change my treatment options (well, I guess I am assuming that there would not be a huge disparity after that third opinion). Also, after surgery, I'll get the more accurate pathology (compared to the biopsy).
 
Incidentally, I wonder if many folks get second opinions after the pathology results (post-surgery)?
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/10/2010 9:28 PM (GMT -6)   
Mel, at what point do you believe anything? With your surgery this close, unless you are planning on changing your mind about your primary treatment, and doesn't sound that way to me, then just wait until after your surgery, then you will have a full pathology report of whatever they remove from you. There is such a thing as over analyzing something. A biopsy, at best, as my surgeon told me long ago, is just and estimate at best, nothing more, nothing less.

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 in place


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 1/10/2010 10:06 PM (GMT -6)   
Your post surgery results are important.  My wife works in a hospital lab and her pathologist carefully reviewed all of my case slides.  I was happy to get the second opinion that matched the original results.
Best wishes for successful treatment.
Dan 
PSA 01/07 1.2, PSA 01/08 1.9, PSA 01/09 2.5
BIOPSY 02/24/09  PCa DX age 52
Right: 3+3=6, 3/6 cores 10% involved,PNI-Y
Left:  3+3=6, 1/7 cores <5% involved,PNI-N
LARP 04/09/09 nerve sparing. Final pathology:
GS 3+4=7, Margins uninvolved, 2 lymph nodes negative
Catheter out 04/17,1st no-pad day 05/03
Followup PSA 05/28/09,08/20/09,12/08/09 <0.1
 
 


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/11/2010 6:22 AM (GMT -6)   
David- mentioned above: " Mel, at what point do you believe anything? There is such a thing as over analyzing something. A biopsy, at best, as my surgeon told me long ago, is just and estimate at best, nothing more, nothing less."

So, never over analyze anything with PCa? I think most of us understand the inaccuracy of biopsies. So David whom does watchful waiting and whom gets invasive treatments and when??? Do we trust and leave it up to your doc, or whomever is the doc in front of us pitching whatever??? What about when you get another opinion that is conflicting, or should patients not look at anything else....it could be over analyzing a life and death decision??

You cannot over analyze cancer and PCa, it never gets defined enough....so a patient gambles...did any doc mention how much of a gamble it is??? They should if they believe in the hypocracy oath (LOL) and full disclosure and truthfulness. There are a number of uro/surgeons whom actually know how risky some patients stats are for successful surgery and yet they do not disclose or tell the patient anything in that direction....welcome to Jungle.
 


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

Post Edited (zufus) : 1/11/2010 9:38:02 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/11/2010 9:46 AM (GMT -6)   
zufus,

my reply was directly and specifically directed to mel's post, not a general statement of fact. i say again, unless the man has any second thoughts about his primary treatment method, which is surgery in this case with a top notch surgeon in a top notch hospital (and if he did have doubts or second thoughts or if something was known now that wasn't known before, then he should put a stop on things until resolved), then any other information or opinions is mute.

you don't need to take 3 different PSA tests by 3 different labs every time you need a psa test. i know that is a bit absurd, but the point is still the same. at what point, do you trust a test result, or a slides results, etc.

at some point, you still have to make decisions and act upon them. if you are going to distrust every doctor you meet, then you might as well treat yourself, and disregard sound medical advice that is based on a lot of experience and practice.

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 in place

Post Edited (Purgatory) : 1/11/2010 8:34:31 AM (GMT-7)


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 1/11/2010 10:20 AM (GMT -6)   
Mel really had the best point, in answer to his own question: He will get a post-surgery path report and that will resolve whatever ambiguity there may have been between different readings of the biopsy slides. I am a big believer in additional opinions, but in this case I think an additional reading of the biopsy slides would probably add nothing.
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/11/2010 10:39 AM (GMT -6)   
I hope my posts were quite clear. I have no doubt whatsoever that surgery is PROBABLY my best option (there is always a degree of uncertainty/probability with all of this).
 
There is no point that I can see in getting yet a third opinion regarding my biopsy as it will not change my treatment.
 
My surgery is in 2 weeks. In 3 weeks I should have a more definitive pathological result, but of course there will still be uncertainty with this disease, regardless.
 
I guess my question was more whimsical than anything else: is a second opinion more valuable/accurate than the first opinion? Is the second opinion completely independent of the first opinion or do they actually look at the first biopsy report (and have that influence their opinion)? I tend to think its the former.
 
I agree with Zufus in that we do need to embrace many opinions as this is a life/death issue. But given the facts as I've stated, I think Medved and David are on target. There comes a point where getting more opinions/tests can be counter-productive.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/11/2010 10:47 AM (GMT -6)   
Good answer, Mel. And good luck as your time approaches. Be real glad when you are on the recovery side of this process.
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 in place


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/11/2010 12:37 PM (GMT -6)   
Mel,
To answer your question; a 2nd opinion by a recognized expert pathologist like Bostich, Epstien or Oppenhiemer is much more valuable then a 2nd opinion from another pathologist. If you are going to get a 2nd opinion for anything then get it from the best available. It doesn't make sense to get a 2nd opinion from anyone who is not an expert. This pertains to everything involving PC.
Being a math teacher you know that everything follows a normal distribution curve. The same goes for doctors. There are a few that are 3 sigmas and these are the ones you want to use. Why use the average when the best is available. This is such a simple concept and it is rarely followed.
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 1/11/2010 1:22 PM (GMT -6)   
Actually, the only way to know which opinion is to get a third.  If it confirms, on of the other opinions, then you have some confirmation. 
 
However, if it is different than the other two, then get another opinion, and see which on it agrees with.  This may entail a 4th opinion.
 
This cycle can get tedious.
 
The other option, as you stated, is to just keep going pn yourcurrent track, and get the post surgery pathology.
 
Then you can start the cycle over to see if that opinion is correct.
 
We really can drive ourselves crazy over this thing !  And in the end, none of it makes a lot of difference to the end result.
 
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


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/11/2010 4:38 PM (GMT -6)   
John T:
 
You really make it sound like the few you mentioned are Gods and everyone else is just a peon. Now, I agree the ones you mentioned are certainly recognized as the very best. But why do I think that pathologists from well-known places (Umich and VUI) are also very good? Yes, I am a mathematician. First of all, not everything follows a normal distribution curve. In fact, not even close. There are many other distributions. (Bi-modal, Poisson, binomial, etc.) Regardless, that point is moot-- unless you advocate my having 1000 pathologists read my slides!
 
Couldn't you make the same case for surgeons? You can mention the top ten and then assume that anyone else is just chopped liver.
 
Ohio State: You are acting like I am being foolish and rushing into surgery. I have studied the issues and I am not rushing, but neither am I dawdling. Having studied the issue, I am well aware of the side effects. You act like I am not. I am certainly NOT ignoring them. In fact, if there were no side effects then perhaps surgery would be a no-brainer.
 
Frankly, I think David hit it on the head when he said that Zufus seemed to take a response and fashion it into the same old mantra (the jungle theme). I think some folks seem to have one particular axe/nail to grind and they turn every post into that hammer. But having said that I also welcome and respect those views. But this is why I strongly recommend to newbies (and I am almost a newbie anyway) that they read all the posts and after perusing a totality of posts they can reach some rational decisions as best they can in this rather irrational disease.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/11/2010 4:46 PM (GMT -6)   
Mel,

I want to stress again, that you have done your homework. With your stats, I honestly think you have picked a good course of action with top notch players, for your primary, and hopefully only major treatment. You have asked all the right questions in your travels. As a group, we back our brother's decisions. And we will back you.

Goodlife, I understood your point, and I believe Mel did too. You can opinion something to death, and ultimately, not every one has unlimited resources and time to collect opinions that aren't going to change the course or outcome.

And Mel, I have preached this the whole time I have been at HW, there are hundreds and hundreds of good surgeons, doctors, radiation oncologists, uro's, etc, that no one here will ever hear about or know at HW, that do wonderful jobs, providing excellent care to their patients. The bad apples are far and few between, and tend to get weeded out by their patients.

You have set a good example of how someone new to the world of PC goes about learning and gaining knowledge, and how one comes to a treatment decision. You have my vote.

David in SC

Post Edited By Moderator (James C.) : 1/11/2010 2:52:40 PM (GMT-7)


goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 1/11/2010 5:30 PM (GMT -6)   
Mel,

I wasn't trying to say anything to you, I was actually just trying to be a little humorous, and point out the problem with second opinions. They are just that, opinions. Every one, even Ohio has one. I really can't for the life of me figure where he is coming from. Some opinions of course are better than other ones based on their expertise,or lack of it.

You have undoubtedly researched the PC topic to a higher degree than most of us. I hope you are feeling as confident as any man does who is about to have something he holds in very high regard worked on.

Good luck, and job well done. We'll see you on the other side soon !

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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/11/2010 6:29 PM (GMT -6)   
Good luck to you Mel remember you can get walkin PSA tests at Crittenton Hospital in Rochester, Mi. for $15, results mailed to you. In case you don't like waiting 3 mos. between psa tests, why wait if you want information???? Why not get a second opinion on PSA tests?
I have gone there a number of times over the years, along with my onco office visit psa tests and compared them, too. Once compared them on the same day a few hours apart, they were very close, but not identical (fyi).
Youth is wasted on the Young-(W.C. Fields)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/11/2010 7:56 PM (GMT -6)   

Zufus:

 

Mixed emotions regarding waiting (head-in-sand-syndrome?).

I am in mid-Michigan, 3 hours from Detroit. So that would not be convenient. I think my regular physician would probably give the lab orders whenever I want, more or less.

 

Mel


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 1/11/2010 8:15 PM (GMT -6)   
Compiler,
It very simple, if you are going to get a 2nd opinion on biopsies slides and relie on the 2nd opinion for a major decision, why not use the best available pathologists; it doesn't cost anymore, involve any travel or time. A regular patholigist may see a few cases of PC every months. The top guys are looking multiple cases a day, and yes they may see something different than a normal patholigist because they are experts in PC.
The exact same goes for surgeons; 80% of surgeons doing prosectamies do less than 10 a year. The top surgeons have less side affects and better cure rates than average surgeons. Why would I have my local urologist do my surgery when I could get Scardino or Walsh. Why in the world would I ever want to use an average doctor when the best are available; why take the chance when you don't have to. These guys are recognized by their peers as being the best because they get better results. I'm not saying that these guys are the only ones that are good, but I am saying that you will get better results if you pick the doctors that are in the top 5% rather than the doctors that are at the median or lower.
JT

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


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/11/2010 8:35 PM (GMT -6)   

John:

 

If I just wanted to choose someone to get a 2nd opinion on the biopsy slides, I would definitely pick one of the top guys such as Epstein.

But, as I said, at the same time I was looking for a top-notch surgeon and I found one in Michigan. They required a second reading of the slides (by them). That's still two readings and I truly doubt that these were below-average pathologists. Umich and VUI are not podunk town USA.

 

Again, given the information in my signature I think I have enough information to decide.

Realistically speaking, do you really think a 3rd reading would suddenly result in a changed treatment plan?

Mel

 


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 1/11/2010 8:47 PM (GMT -6)   
Mel, Sound like you have done your homework. Best of luck on your decision and your healing path.

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/11/2010 8:50 PM (GMT -6)   
Mel,
While I generally agree with multiple opinions, I, like you, find redundancy in checking again what two pathologist from different centers have found as "actionable" biopsy reviews. In other words, another review by Bostwick or Epstein likely won't change what action is appropriate with the first two findings. But if you like, get another review, I had three and one was with Epstein. But they were all similar findings.

You have multiple choices available on how to proceed, and as I said before, Dr. Menon is a well established prostate cancer expert oncologist and surgeon. There are no one single experts that are "the best" and if anyone makes that claim, that's when you should run fast away from them.

Tony
Prostate Cancer Forum Co-Moderator


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/11/2010 11:33 PM (GMT -6)   
Mel,
I did not properly convey what I was trying to say. I wasn't talking at all about your situation, but answering your "whimsical question" about the value of a 2nd opinion of biopsy slides in general. In your case it makes no sense to get a 3rd opinion. For others considering a 2nd opinion they should get it from one of the top pathologists for the reasons stated; if a change in readings either up or down wouldn't change your decision choice then there is no reason to get a 2nd opinion.
JT

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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/12/2010 3:43 AM (GMT -6)   
I am sensing the need to put this out there for a few of our group members,

Compiler has made it clear his intentions on how he will treat his prostate cancer and has been met with unsupportive resistance by some of our members. For those doing so, please cool the jets on your attempts to recruit him to your beliefs and philosophy about what you think is best for him. His decision on treatment modality and methodology is neither wrong nor irrational. I would say the same in fairness for the decisions of those who are critical of him have made. But it is disrespectful to continue to try to push the matter any further.

We don't have to subscribe to the decisions anyone here makes. We would better serve the forum by providing support and understanding for the patients regardless of their decisions.

Forum Rules
Don'ts...
11. No posts of an overtly political or religious nature OR posts promoting advocacy of particular personal, medical, legal, religious, political, or non-profit causes. The forums are intended for offering mutual personal support. Debating controversial subjects should be taken elsewhere...

Do's...
4. Use good judgement. NEVER rely on information or opinions exchanged via the forums or chat rooms to replace necessary, personal consultation(s) with qualified health or medical professionals to meet your individual health or medical needs. Remember that what's right or has worked for one person may not be what's right for another.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 1/12/2010 2:17:03 AM (GMT-7)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 1/12/2010 7:58 AM (GMT -6)   
Mel, my only comment is good luck with your surgery on the 25th. You have done a great job of trying to understand this disease and your options, and your posts have always been thought-provoking.

I know you still have close to two weeks left before your surgery but wanted to let you know that John and I are wishing you nothing but the best outcome.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!

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