Will Biopsy Spread PCa

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BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 3/20/2010 5:55 AM (GMT -6)   
Great discussion yesterday about when and where PCa will spread. I had perineile (sp?) invasion and have often wondered if I should be concerned about it. My surgeon down played it. All that mattered was that the tumor was fully contained. I have also wondered if biopsy will spread PCa in a person will a high gleason. Dr Walsh says "no" in his book. He says that cells will die off if not attached to the prostate (maybe 3's, but how about 4&5's). But how can he know how PCa ultimately spread when there has been a re-occurance. If then can get out and survive through the perin. blood vessels, what happens wen chucks get broken loose in biopsy. Thoughts?
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


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 3/20/2010 6:01 AM (GMT -6)   
I am certainly no expert but I have not heard of a situation where having a biopsy spread PCa. On the flip side I think the biopsy is a life saver. One thing is sure when it comes to cancer is that it does not follow a standard protocol. Cancer has a mind of its own unfortunately. I will be watching this thread to see how others answer.
Thanks for the question

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 3/20/2010 6:04 AM (GMT -6)   
B, perineural invasion is a common finding. In fact, it's so common that some doctors don't even make note of it. Since you had surgery, the important aspects of your pathology would be clean surgical margins - sounds like that's what you have and this is the ultimate goal of surgery.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs 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, March 2010 0.0. Next PSA in 6 months. Thank you God!


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 3/20/2010 6:35 AM (GMT -6)   

There is no evidence to indicate that a prostate biopsy is associated with spread of cancer. Besides that, any potential risk far outweighs the necessity for the biopsy to establish the diagnosis and, if cancer is detected, to begin the start of appropriate treatment.

from another BB-fan...


tatt2man
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Date Joined Jan 2010
Total Posts : 2840
   Posted 3/20/2010 6:45 AM (GMT -6)   
- back in October 2009, when I went into to my urologist for the first meeting , there was one of those pamphlet magazines .." and so you have prostate cancer.." NO I DON'T - was my first internal reaction - I had no desire to spend the waiting time looking at everyone looking at each other (or not) in the waiting room for several doctors - so I picked it up and read it ... two main points stuck in my head - prostate cancer symptoms and testing increases men's chance of heart attack ( from simply worry or fear) and the biopsy can possible spread the prostate cancer ... HECK NO ... was my internal response... I spoke to my urologist about that and he stated that the risk was small, but as with any invasive procedure, there is risk.
-when researching for my posting here I stumbled on one doctor who was very ANTI-BIOPSY, who came across as an reformed hippy doctor who trusted no one except for his minimal non-invasive checking system... he took the small risk and had it overblown by suggesting to the reader they set about and puncture repeated a apple or pear and see what happens to it over the next few days - SEE WHAT HAPPENS ! - that is happening to you ! - such a scaremonger - no relationship to antibiotic ( to reduce / eliminate infection) - no relationship to cleansing the area beforehand with enemas.... no relationship at all to how the body naturally heals itself ...

-if the scaremongers were right, the success rate of any type of treatment against prostate cancer would be futile ....

- if the biopsy is already done - don't worry about it .. you have enough on your plate already....
-if the biopsy has not been done - talk to your doctor about your concerns and if necessary, seek out alternatives, so you can help chart your path on this journey...

- right now, I do my best by only worrying about what I am going to cook for dinner ( I am the chef in the house)

non-invasive hugs
BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/20/2010 7:01 AM (GMT -6)   
First, what is a BB_Fan? Must be another case of me not getting the obvious.

I asked your question to my GP, URO/Surgeon, 3 radiation and 1 radiation oncologist, and they all said that they had never known or heard of a case of PC being spread by a biopsy. One of the radiation oncologist, the most conservative of the 3, said in theory, it could be possible, as the needle retracts back through the rectal wall with the core, but again had never heard of case where it was suspected.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 3/20/2010 7:44 AM (GMT -6)   
Thanks for the replies. I was not suggesting that men shouldn't get biopsies. I agree that they save lives. Most men, those that present with a gleason 6, would not have a concern. However, it seems to me that it you have an aggressive cancer you are just as likely to have it spread from biopsy as perineural (thanks for the spelling) invasion. I agree that Drs probably have not seen cases of this, but how could they ever tell anyway. They could never know how it spread when the tumor is capsule contained.

By the way. I is basket ball fan. There isn't a better time of the year than March.
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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2211
   Posted 3/21/2010 2:13 AM (GMT -6)   
And there was me thinking it was a Bridget Bardot fan!

I would assume that if a biospy is done properly there is no risk, but if say the sliding part of the needle jammed open and when retratced the core fell out and left a whole chunk of tissue between prostate and rectum then that could be a risk.

And on a related subject what risk is there during a prostatectomy that as the surgeon cuts bit up and off and the lifts the prostate, seminal vesicle etc out of your body that bits fall off and get left behind? (After all some surgeons have failed to notice that they've dropped surgical instruments etc and left them in patients.)

Alfred

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2840
   Posted 3/21/2010 4:10 AM (GMT -6)   
I thought you were a Boston Bruins fan !
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/21/2010 4:19 AM (GMT -6)   
Yea, but Alfred, there are lots of things that "could" happen, but these are what one calls "massive" odds.

It's kinda like playing Powerball. Ya gotta know that you are simply donating money on a regular basis to support the school system. As long as you understand that's what's going on, then fine...but most sheep don't understand that.

Wait, I just looked it up, one is actually far more likely to have a surgical instrument left inside them than win Powerball!


By the way, I am both a Bridget Bardot fan :-), AND a (college) basketball fan! Been to seven Final Fours.

deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 3/21/2010 7:10 AM (GMT -6)   
my take is like the rest of you guys I don't think biospies spread PC but who knows !!!!!!!!!!! nothing is a for sure with PC the more you learn the more you don't know . in my case i had perineural invasion surgical margins and psa back in 6 mths.

DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 3/21/2010 7:18 AM (GMT -6)   
my take is like the rest of you guys I don't think biospies spread PC but who knows !!!!!!!!!!! nothing is a for sure with PC the more you learn the more you don't know . in my case i had perineural invasion surgical margins and psa back in 6 mths.
P<S> how do you know if the cancer was small cell my first rad.dr. said i was in a 1% bracket for this type of PCancer that he had only one other patient 46 yrs old that had this to. at the time i wasn't sure what he meant. and didn't know to ask.
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/21/2010 9:25 AM (GMT -6)   
my honest guess about the BB part, was perhaps B.B. King, , and Alfred, tsk tsk, you dirty old man having carnal thoughts about Bridget, lol. Actually, probably be good therapy for you to have such thoughts.
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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2211
   Posted 3/21/2010 10:02 AM (GMT -6)   
My thoughts are still that there while there is a risk that all sorts of things can happen the risk of a biopsy spreading the cancer has to be too small to be significant.

Alfred

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 3/21/2010 3:19 PM (GMT -6)   
Bridget Bardot!!! I would have thought a young guy like you would be more interested in someone like Madonna.

Dr Walsh acknowledges in his book that biopsy likely causes some cancer cells to brake loose, but says that is unlikely that they are hardy enough yet to live outside the prostate. If they are I assume that they could spead the cancer, bt agree that the odds are probably low.
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


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 3/21/2010 8:22 PM (GMT -6)   
I thought BB_Fan was for Baseball! According to Walsh (Johns Hopkins) and Scardino (Memorial Sloan-Kettering), it is extremely difficult for cancer cells to survive outside the prostate if they were to break loose during a biopsy. On the other hand, metastasis is a different mechanism whereby the cells have a stronger affinity for survival out of their element.

By the way BB, did Dr. Wagner do your surgery? Just wondering because my surgery was done at Hartford Hospital also.
Dx: in 6/2005 at age 49
PSA tests 3/2005: 3.8 ng/ml, 4/2005: 4.1 ng/ml, Stage: T1c
TRUS biopsy: 2 out of 10 cores positive, Gleason 6 (3+3), bone scan: neg.
daVinci Robotic Prostatectomy 8/2/2005
Post-surgical Path report: upgraded to Gleason 7 (3+4), pT2c, NX, MX.
neg. surgical margins, neg. seminal vesicles, neg. vasa deferentia
Perineural invasion: present
prostate capsule: tumor focally invaded into, but not beyond prostatic capsule.
Post-surgery PSA tests, all <0.1 ng/ml for about 4 yrs.
Then on 7/23/2009: 0.1, 10/16/2009: 0.2, retested 10/23/2009: 0.1, 1/22/2010: 0.2.
Switched to more sensitive test on 2/5/2010: 0.14 ng/ml.

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