Second Opinion?

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/21/2010 11:31 AM (GMT -6)   
I'm wondering if many of you have chosen to get a second opinion on your pathology slides and if so was it much different.
 
I have decided to get a second opinion. I'll be faxing the paperwork to send the stuff to Jon Epstein at Hopkins.
 
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

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. 

 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.

Next Event: First post-op PSA on 3/1/10


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 2/21/2010 11:35 AM (GMT -6)   
I guess there is no harm. With a questionable report might not be a bad idea. You PSA will let you know what is really gong on in the future.

Jeff T
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)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/21/2010 12:02 PM (GMT -6)   
mel, what are you hoping it will show? if it is the same, then it wasn't needed. if its better, you can't undo what you have done. if its worse, which one do you believe, the better one or the worse one, or do you then get a third opinion and go for best out of three?

not being a wise guy, just trying to understand your thought process here. the bottom line is, your prostate is gone forever, along with the bulk of your cancer. what may or may not happen next, who can say? the jury is out. you still haven't had your first post surgery psa test yet, that will be your new base line, will make all your previous psa tests meaningless in a sense of the word.

i had thought about having mine read elsewhere, because i am suspicious that because of my positive margin, my quick recurrance, and my psa velocity both pre and post surgery, that i am really a stage 3, not a stage 2. but when i think through the process, i come back to the same choices i mentioned above to you.

you can't unscramble eggs as the country folk like to say. so for me, it is what it is, and i deal with one episode at the time.

you need to reach some point, perhaps not now, when you are not so consumed with all the "what ifs" in your case and in PC in general. I know its hard to do, but you can drive yourself crazy.

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


Worried Guy
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Date Joined Jul 2009
Total Posts : 3743
   Posted 2/21/2010 12:48 PM (GMT -6)   
Mel,
I'm with David on this one. What do you hope to gain? No matter what the results show, you cannot change what you did. Will you be second guessing your PSA tests too?
If you were paying for the reevaluation as a full out-of-pocket expense, would you do it?
Jeff
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots, See Uro 1/22/10 Trimix unsuccessful.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.


John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 2/21/2010 12:53 PM (GMT -6)   
I'm with the advice the guys are giving you. Information is either useful or not useful. If you can't do anything with the added information is is not useful. PSA and not the pathology will dictate your next steps.
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
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/21/2010 3:10 PM (GMT -6)   
After my surgery my pathology of the prostate was reviewed by Epstein. It was merely confirmed. Would I do it that way again. Absolutely. We are not talking about a huge expense here. I wanted confirmation before taking on adjuvant therapies, and that makes sense to me. If you are considering additional treatment options before a rise in PSA, then why not have a review of the pathology? If it is perhaps reduced in aggressiveness, then you might think twice about proceeding. If it is confirmed than, you have that much more confidence moving forward with an aggressive plan. Will it change, not likely. But each step from here should be calculated and measured against the potential side effects.

Tony
Prostate Cancer Forum Co-Moderator


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 2/21/2010 3:46 PM (GMT -6)   
Yes x 3 Pre Operative
Yes x2 Post Operative
Learn anything …NO
Do it again…Yes
Hero
Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.


BillyMac
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Date Joined Feb 2008
Total Posts : 1858
   Posted 2/21/2010 3:57 PM (GMT -6)   
I tend to agree with Tony on this one. While looking at adjuvent treatment ( it was far past the time to be described as adjuvent though) the radiologist sent my post surgery slides to be checked by a different pathology lab. Initial biopsy said 4+3, post surgery said 4+4 and the recheck said 4+3 but this time specified the grade of cells at a focal EPE (grade 3). For some, had this EPE been the more aggressive grade 4 cells, that may have tipped the decision to have adjuvent radiation in attempt to knock them out.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/21/2010 4:38 PM (GMT -6)   

You all raised good points, mirroring my thinking. I was not going to get a second opinion, figuring that it will not impact any subsequent treatments. In fact, the only reason my biopsy got reviewed was because I had the biopsy done in one place (u. of Mich) and decided to have the surgery done in another place (Dr. Menon at Ford Hospital). They required a second reading.

However, Dr. Strum does urge very strongly that a second opinion be obtained. In my case, it is conceivable that a second opinion might result in a decision to do adjuvent radiation. It probably will not, but it might.

REGARDING cost, that is not an issue for me. I have good insurance that I THINK covers it (I have an inquiry in to them). If I read Dr. Epstein's site correctly, it is $200, but it might be more (one part was unclear). Regardless, Jeff, if I decide to do this and I have to pay the full cost, I would. But that is also a question related to personal finances, too.

 

David -- you said, "reach some point, perhaps not now, when you are not so consumed with all the "what ifs" in your case and in PC in general. I know its hard to do, but you can drive yourself crazy."

In a sense, you are correct. However, I would hope that every time I post a question, YOU do not conclude that I am obsessing about PC. I think I asked a very legitimate question and I got some interesting replies. 

Mek


 

 


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

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. 

 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.

Next Event: First post-op PSA on 3/1/10


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 2/21/2010 5:31 PM (GMT -6)   
Hi Mel,

I try to think of optional testing by framing a question to myself "Would I pay for it?" For example, you know me, I would love to know my PSA every month. But if I had to pay for the test out of my own money, $100, I would not do it. Instead I wait 3 months and have insurance pay. In a way that keeps the nation's health care costs down. I saved everyone on this site a billionth of a cent. (You're welcome!)
If you honestly think the results would influence your decision then you are justified. But if you are already leaning to not doing adjuvant, then is there a point in the second opinion on the slides? I was borderline. But with the ED and incontinence and knowing that odds are once I started radiation I would most likely not improve I decided to wait and let my future PSAs decide for me.
Jeff

goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 2/21/2010 6:01 PM (GMT -6)   
Mel,
 
I would say if you are considering adjuvant radiation, then it can't hurt.  If you are adopting the wait until .5 routine, then it may be a questionable exercise.  The $200 may be better spent as a donation to PC prevention.
 
It is my guess because of the ability to carefully select the best slides that represent your PC, as opposed to a biopsy where there is only a very samll amount of tissue that has been jammed into a needle, the odds of having a different grade is slim.  There are howver, some different variant result numbers that may be able to indicate agressiveness that if JH does them, may be a big help.
 
Obviously, it's all your show at this point.
 
 
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/21/2010 6:03 PM (GMT -6)   
mel, there was nothing wrong with your question, something we all have had to think about.

my remark was generalized, and it pertained to me too.

certainly wasn't meant to offend, just speaking off the cuff.

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


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 2/21/2010 8:30 PM (GMT -6)   
Compiler

I chose to get a second opinion from another Dr. The second Dr. had me send the slides to him and he told me he was not going to consider operating on me if I didn't have prostate cancer. By the way the second read on the slides were the same as the first. The second opinion was because I didn't trust my first uro and neither did my wife or son. So there you have it.

Good luck to you

Mika
age at dx 54 now 57
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
ED is getting better
the shots work great, still can't give them to myself
two years of zero's
Retired again after 36 years February 1, 2010


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 2/22/2010 6:36 AM (GMT -6)   
You mentioned sending the paperwork for a second optinion...Didn't you mean you'll be sending samples/slides/body parts to be retested for the second opinion?
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
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 2/22/2010 7:40 AM (GMT -6)   
I second Steves remarks,

What would sending the paperwork do as for a second opinion. I could see you sending the actual slides or frozen cells to get them reviewed. Seems like you could only get the same same reading from a "reading" only sample, How realistically could they differ ?

I also would wait to see what the post-op PSA shows first before taking any other action.
Stats:
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/22/2010 9:02 AM (GMT -6)   
General question....do they even keep those tissue samples? It would seem to me that they would somehow maybe take a picture of the microscopic samples for viewing later on...but the actual samples are destroyed and not available as they would deteriorate rapidly. I am sure that the cost of trying to preserve tissue samples would only be done under teaching or study conditions and not the general rule of thumb for pathology.

So having a different pathologist look at a pictures of tissue samples could conclude a different reading, but not likely.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 2/22/2010 9:08 AM (GMT -6)   
Mel...one more thought...check to see if your particular lab that performed the pathology was reviewed by more than one pathologist. In my case my pathology was read by several doctors independently and then signed off by the head pathologist. In essence I had several path opinions with a final conclusion based on those independent readings.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


Tamu
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Date Joined Oct 2006
Total Posts : 626
   Posted 2/22/2010 9:43 AM (GMT -6)   

When I was diagnosed with PCa the local urologist did not do a very good job of informing me about treatment options and was promoting open surgery because that is what he did.  I had always told myself if I ever had a serious health issue I would get a second opinion from a major medical center.  That is what I did.  I went to Vanderbilt Medical Center.  Their protocol is to have the slides read by their pathologist so my slides were read again and they came back with atypical cells but no adenocarcinoma.  The Vanderbilt urologist explained this happened 3 or 4 times a year and when this occurred the protocol was to send the slides to Dr. Jon Epstein at John Hopkins.  My Vanderbilt urologist explained to me in the years they have been following this process when Dr. Epstein read the slide as having adenocarcinoma the post op pathology had always confirmed he was right.  In my case Dr. Epstein did read my slides as having adenocarcinoma.  I have read somewhere in one instance a prostate was removed based upon a biopsy and it did not have cancer. 

Tamu


Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


Herophilus
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Date Joined Sep 2009
Total Posts : 664
   Posted 2/22/2010 10:52 AM (GMT -6)   
Pathology slides once fully fixed should be available for years to be reviewed.
Hero

MrGimpy
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Date Joined Jul 2009
Total Posts : 504
   Posted 2/22/2010 11:35 AM (GMT -6)   
Hi Here,

What do you mean by fixed ? Does that mean they are able to be transported to other labs. Does that also mean that there is repository that hold our slides for years ?
Stats:
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 2/22/2010 11:41 AM (GMT -6)   
yes, they are physically transported to other labs. Slides have a glass disc put over the specimens, with a glue type agent that seals them.
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


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/22/2010 12:14 PM (GMT -6)   
For those who asked, I was referring to the paperwork to send/fax to Ford Hospital to send my slides to Jon Epstein at Hopkins.
 
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

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. 

 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.

Next Event: First post-op PSA on 3/1/10


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 2/22/2010 1:22 PM (GMT -6)   
Mel- do whatever your desire to do is, nobody else walks in your shoes. Let me say to others that PRIOR to making a decision upon any major modality/treatment that is non-reversible get the best friggin pathology you can get, in straight words the handful of real experts whom know this is the best thing you do for yourself...the others are wanna be'sssss...wanna get best info for prognosis??? Maybe in some cases it doesn't matter...how do you know if you are 'some cases or not'???  Mel I told you see Bostwick first thing on pathology(posted on this forum) and I noticed Dr. Strum replied recently to you and said exactly why and what was lacking on your prior pathologies, that  Dr.Strum  noticed and picked up on, right away. Esptein and Oppenheimer etc. are some of the few others that are worthy. I think that Epstien does not do ploidity analysis, but you probably aren't looking for that...but if you are going this far, why not spend a couple more bucks to know.
 
Also(for others), even if it costs additional money (and it does for optional pathology things like DNA ploidity analysis and some other things they can do)...maybe pay for it and find out more about what is your dragon version of PCa...there are not only many Gleason scores, but many variants types of PCa that the local patho-doc probably would not even notice the difference, they don't come with a tag on them, and ploidity analysis is more important than you might know...especially as to how you will fair long term...or the value of subsequence drugs and therapies that might be used against your case of PCa.
 
Enter the twilight zone of PCa...jungle...limbo land


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


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 2/22/2010 1:47 PM (GMT -6)   
 
I wish I had requested it right after my surgery my post-op report came back so good and I was so relieved I did not even think about it Gleason 6 organ confined etc.  Nine months later PSA started to go up and they relooked at the slides.  Now they say the pathologist made a mistake and it is a Gleason 8 very aggressive, if I knew that at the time it might of changed the way I did my follow up treatment.  I then also had it sent to the best Johnathan Epstein at John Hopkins, he came back also a Gleason 8 and said it was a slam dunk 8 there should never have been a question.  So I agree with you get another opinion from the best then go from there.  I waited a year for salvage radiation because they said I had a slow growing cancer and radiation not necessary, then it turns out I have a very aggressive cancer and  who knows what could have happened in that year.
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/22/2010 3:12 PM (GMT -6)   

Regarding costs, I just heard from my insurance company. They do cover second opinions. In this case, Epstein is out-of-network so insurance covers 70% (it would be 90% in network).

As I said, I would pay for this out-of-pocket if it wasn't covered. With some of these situations the information CAN prove invaluable.

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

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. 

 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.

Next Event: First post-op PSA on 3/1/10

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