Pathology report second opinion

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BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 3/15/2010 7:26 PM (GMT -6)   
A lot of great advice available in this forum. I have read a number of posts on the importance of having a pathologist or lab that has an expertise in PCa assess cancer. I have decided to get a second opinion and woukd really appreciate some suggestions. I am in the Northeast US (don't know if that really matters). How is this normally done? Do you just call the Dr/lab to arrange it?
Dx with PC Dec 2008, PSA 3.4, Biopsy: T1c, Geason 7

Robotic Surgery March 2009 Hartford Hospital
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 3/15/2010 7:54 PM (GMT -6)   
Just tell your doctor that you want Epstien at Hopkins to review your slides and he should arrange it.
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


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 3/16/2010 8:45 AM (GMT -6)   
BB:
You may certainly ask for another pathology report from an expert. My question is what this information would provide you that would change your course of treatment, if any?
An expert opinion pre surgery or pre radiation is an excellent idea to determine and target the primary treatment. After primary treatment, psa is a finely sensitive measure of disease state independent of pathology results.
tarhoosier

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 3/16/2010 9:04 AM (GMT -6)   
BB,

At first I thought you were asking about a second opinion on the biopsy. Then I read your signature. Your surgery was done almost 9 months ago and you have been getting good PSA results.

What are you looking for in a second opinion now?

Much has changed about your body and any cells left over since your surgery. What will this 2nd look at the old tissue tell you?

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 3/16/2010 10:13 AM (GMT -6)   
I don't think another Path report would be worthwhile this far out after RP. Your PSA's are good thus far. It wouldn't really any effect on future PSA's. You had a great path report after surgery and that should suffice. Get well and try not to take on any unneeded stress. Just a thought.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00

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