Needed experienced Pathologist to review biopsy slides ... and unfortunately it's cancer

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An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 5/10/2010 10:49 PM (GMT -6)   
Hello all,
 
My husband had a biopsy a couple of weeks ago which came back as ASAP. Which, after reading the links that were kindly given to me by people in this forum means that that the the small areas of the biopsy looked suspiciously like cancer but because of their characteristics and small size could not confidently be diagnosed as cancer by the pathologist. ASAP is a conservative diagnosis as pathologists are not keen to label something cancer unless they are very confident it is. However, obviously it does depend on the skill and experience of the pathologist and I have no idea is the pathologist that diagnosed my husband's biopsy was straight out of school, or doing 100's of these every year.
 
So I would like a second opinion, John T suggested John Hopkins but we live in Sydney, Australia. Does anyone know of an experienced pathlogy lab in Sydney or the name of a pathologist who has strong experience in PC that that could review these slides? The report that we currently have was done by SEALS - South Eastern Area Laboratory Service.
 
An


Husband's age: 52
 
In 2007 my husbands PSA levels were 2.5.
In Feb 2008 they were 1.7
In Oct 2009 they were 3.67 with a free PSA ratio of 27
In Feb 2010 they were 4.03 with a free PSA ratio of 31.
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."
 
Review of biopsy by experienced pathologist, results,
1 out of 12 core diagnosed with 10% of Gleason score 3+3 cancer (left transitional) 
1 out of 12 cores with ASAP (left apex), suspicious but not diagnostic of cancer

Post Edited (An38) : 6/8/2010 4:54:00 AM (GMT-6)


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/10/2010 11:31 PM (GMT -6)   
An,
I had my post surgery pathology done by a very reputable pathologist associated with St Vincents in Sydney. I had that pathology reviewed by what I was told was the most reputed pathologist in NSW. I don't have the details on hand at the moment but will dig out my reports when I get home and post their names later. But I must say given the old man's biopsy result and the reasonable free PSA levels I would not be worrying too much.
Bill

Biopsy
4 of 10 cores positive for Adenocarcinoma-------bummer! 
Core 1 <5%, core 2----50%, core 3----60%, core 4----50% 
Biopsy Pathologist's comment: [/color]
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 
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   PSA May '10  <0.01


www.yananow.net/Mentors/BillM2.htm


Never underestimate old people ............ you don't get to be old by being stupid.


An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 5/11/2010 2:01 AM (GMT -6)   
Hi Bill,

Read your yananow website. Very impressed by your struggles and wins with the pathology companies.

I think the ASAP result is a bit of a cop-out. I guess I have difficulty with accepting some faceless pathology person giving us a result like this. I don't know if he spent 2 minutes on it or 20. If it is the correct result confirmed by a pathologist experienced in prostate issues then I am more than happy with it.

It is hard not to worry, it would be heaps easier if it was me. But the emotional side of things is something I can put aside, I just want to take the thorough & logical approach - I can see from your website how important it is to question doctors and to do your own research.

An


Husband's age: 52
 
In 2007 my husbands PSA levels were 2.5.
In Feb 2008 they were 1.7
In Oct 2009 they were 3.67 with a free PSA ratio of 27
In Feb 2010 they were 4.03 with a free PSA ratio of 31.
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/11/2010 2:12 AM (GMT -6)   
An,
My initial post surgery pathology was done by Dr Wade Barrett through St Vincents Private Hospital pathology dept and the specimen was re-examined about six months later by Dr Warick Delprado of Douglas Hanly Moir Pathology. I remember my uro commenting that these were recognized as among the best pathologists in the state with Delprado perhaps having the edge, reputation wise.. Even so their findings were slightly different with the first reporting 4+4=8 and the second reporting 4+3=7, but in my case it does not take much to tip you over from one to the other. Hope this helps and you are adopting the correct approach.
Bill

Post Edited (BillyMac) : 5/11/2010 1:18:31 AM (GMT-6)


An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 5/11/2010 7:59 AM (GMT -6)   
Thanks a lot Bill, that solves the problem.
Appreciate the fact that you looked through your reports for me.

An
Husband's age: 52
 
In 2007 my husbands PSA levels were 2.5.
In Feb 2008 they were 1.7
In Oct 2009 they were 3.67 with a free PSA ratio of 27
In Feb 2010 they were 4.03 with a free PSA ratio of 31.
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 5/11/2010 9:42 AM (GMT -6)   
For an expert pathology second opinion, you could contact Dr. Helmut Bonkhoff. See http://prostapath.org/us/us-main.html He has been recommended by Dr. Strum, who is a very well-regarded prostate cancer oncologist in the US. Dr. Bonkoff is located in Germany, but works routinely with patients from the USA -- and I imagine he could just as easily work with a patient in Australia. Best wishes.
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 5/11/2010 4:29 PM (GMT -6)   
Hi An,
 
Billy has got this one nailed for you, I also had my surgery and pathology done at the St Vincents Hosp, Sydney.  My doctor was Dr Philip Stricker, I can not recommend him highly enough, should you require further treatment. But lets hope you never get to meet him.
All the best...................Kev
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week. ED- okay with Meds.
PSA at 12mths no change remains 0.03
"Everyday in Everyway I get better"


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 5/11/2010 6:43 PM (GMT -6)   
Bill,

Read you history - congratulations to you beating all odds...

Regards,
Sharp

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 6/8/2010 5:21 AM (GMT -6)   
Hello all,
 
We the results have just come back from the more experienced pathologist recommended by Bill - Dr Delprado.
Unfortunately he has diagnosed my husband with prostate cancer - 10% of one core out of the total 12 cores is Gleason 3+3. mad It is in the
But there is another suspicious area in the Apex.
 
I am in shock, I still have to break the news to my husband as the results came in the mail.
I am quite amazed that the urologist hasn't even bothered to call yet.
 
I think we will need to carefully consider our options - the two names I have for good prostate surgeons are Dr Phillip Stricker (from NotHard) and Bill I think you mentioned somewhere a surgeon in the Sutherland shire who does nerve transplants if nerves have to be removed. Do you remember the name of the surgeon? Anybody elses thought's on who I should research would be much appreciated.
 
Regards,
An
 
 
 
 


Husband's age: 52
 
In 2007 my husbands PSA levels were 2.5.
In Feb 2008 they were 1.7
In Oct 2009 they were 3.67 with a free PSA ratio of 27
In Feb 2010 they were 4.03 with a free PSA ratio of 31.
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."
 
Review of biopsy by experienced pathologist, results,
1 out of 12 core diagnosed with 10% of Gleason score 3+3 cancer (left transitional) 
1 out of 12 cores with ASAP (left apex), suspicious but not diagnostic of cancer

Post Edited (An38) : 6/8/2010 4:54:26 AM (GMT-6)


rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 208
   Posted 6/8/2010 8:08 AM (GMT -6)   
Hi An,

Sorry that your husband was diagnosed with pc-my husband was diagnosed 3/10. I know it's a shock, but at least it's a gleason 6 and only one core of 12. When my husband's urologist gave us the news and said it was a gleason 6, I turned to my husband and said, " That's good !" He looked at me like I was crazy, but I had been researching pc and was relived that it was such a low score. With your husband's numbers you have plenty of time to research your options. I, too, am amazed that your uro hasn't called. We got the news from our uro in his office face to face. He had us come in at the end of the day and gave us unlimited time. Good luck on finding the best option-once again, I'm sorry but I know you'll find lots of support on thios site.

Kind regards,

Renee
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
DaVinci surgery with Dr. Vip Patel scheduled 8/9/10
 

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