Second opinion lab recommendations.

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Jim is sick
Regular Member


Date Joined Mar 2010
Total Posts : 118
   Posted 6/3/2010 2:36 PM (GMT -6)   
I think I am finally at the point that I can psychologically handle working on my second opinion. I asked the doctors office if it wasn't too late, biopsy was done in Feb. They are asking me where I want them sent. I know I have not been the "perfect" member of this little group. And I know I have already been given information on this topic, but if you'all could tell me any useful info to help me decide which one to send them to I would appreciate it. Thanks in advance, Jim
 
PS the doc told me there is no rush, and I'm taking full advantage of my time left. I'm not getting into any hurry on this...
 
 
48, Caucasian, 5' 8", 200lbs, 190lbs, general good health.
PSA: 8-7-09 3.22, 11-13-09 4.25.
Biopsy: 32 cores. 3 cores reveal PCa, 10%, Gleason 3+3=6, T1C.
Diagnosed: 2-12-10.
Current Treatment: Active Surveillance, next appointment Oct. 2010. No meat, no dairy, lots of fruits and vegetables.
Preferred Treatment: I just want someone to harvest my immune cells, genetically engineer them to fight my prostate cancer, and then infuse them back into my body...


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/3/2010 2:59 PM (GMT -6)   
Try this link:

https://www.bostwicklaboratories.com/global/services/laboratory-services/second-opinions.aspx

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 6/3/2010 4:37 PM (GMT -6)   

Other options:

https://www.ourlab.net/index.asp

or

http://www.prostapath.org/us/us-main.html

 

 


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
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 6/3/2010 5:47 PM (GMT -6)   

Jim...might as well send them to PCa pathology experts.  I could recommend two:

1.  Bostwick, as mentioned by Casey.

2.  Epstein at Johns Hopkins: http://pathology.jhu.edu/department/services/consults/urologic.cfm

Good luck.

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6946
   Posted 6/3/2010 5:53 PM (GMT -6)   
Bostwick would be my suggestion.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/3/2010 8:01 PM (GMT -6)   
It would almost seem like it makes sense for health insurance providers to require a 2nd opinion on something as important as PC biopsy repots. It could save millions in over treatment cases, if it were required before any primary treatment for PC be approved. The time frame it would take to get the 2nd opinion would not endanger any patients (I wouldn't think) in carrying out the 2nd opinion. Just another way health care costs could be contained to some degree without a risk to the patient. A second read is a lot cheaper than a race for a major operation or radiation treatment that might not even be needed. Just a thought.

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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


larch
Regular Member


Date Joined Apr 2010
Total Posts : 47
   Posted 6/3/2010 9:30 PM (GMT -6)   
Jim,

If I had your numbers, they would need a gun and someone who I was convinced knew how to use it to perform any surgery/procedure/radiation

Your problem is that Hopkins and the Germans both have studies saying that 30%+ of Gleason scores from initial reads of biopsies are too low.

If you have a 7 and not a 6, you are playing in a much more serious league, meaning AS is off the table, and you can trash all the 'overtreatment' articles - they have no meaning for you.

So follow the recc's for the second opinions, and if you are still a 6 with a low % involvement, celebrate, continue the testing, and stay away from actual treatment.
If the second opinion is a 7, then you are in the treatment selection process, not in a full urgency mode, but still, unfortunately in the game

Good luck and I hope the second opinion stays at 6.

PS, the score drops not never, but not anywhere near as often as it rises. Sorry.

Jim is sick
Regular Member


Date Joined Mar 2010
Total Posts : 118
   Posted 6/4/2010 8:00 AM (GMT -6)   
Bostwick it is. Thanks guys, I will post the results.

Larch said:
"Jim,

If I had your numbers, they would need a gun and someone who I was convinced knew how to use it to perform any surgery/procedure/radiation"

Preaching to the choir here. I'm fighting to keep my prostate as long as is practical. ;)
48, Caucasian, 5' 8", 200lbs, 190lbs, general good health.
PSA: 8-7-09 3.22, 11-13-09 4.25.
Biopsy: 32 cores. 3 cores reveal PCa, 10%, Gleason 3+3=6, T1C.
Diagnosed: 2-12-10.
Current Treatment: Active Surveillance, next appointment Oct. 2010. No meat, no dairy, lots of fruits and vegetables.
Preferred Treatment: I just want someone to harvest my immune cells, genetically engineer them to fight my prostate cancer, and then infuse them back into my body...


Jim is sick
Regular Member


Date Joined Mar 2010
Total Posts : 118
   Posted 6/9/2010 8:42 AM (GMT -6)   
I directed my uros office to send the slides to Bostwick. Should I be involved with the process? Are there questions that I would be interested in answering concerning what they do with the slides? Will this involve any profiling of the cancer? I mean will they tell me anything more about the strain of cancer? I emailed Bostwick about this but did not get a reply.

If Bostwick does not profile or categorize the cancer, who actually does? Thanks for any helpful advice.
48, Caucasian, 5' 8", 200lbs, 190lbs, general good health.
PSA: 8-7-09 3.22, 11-13-09 4.25.
Biopsy: 32 cores. 3 cores reveal PCa, 10%, Gleason 3+3=6, T1C.
Diagnosed: 2-12-10.
Current Treatment: Active Surveillance, next appointment Oct. 2010. No meat, no dairy, lots of fruits and vegetables.
Preferred Treatment: I just want someone to harvest my immune cells, genetically engineer them to fight my prostate cancer, and then infuse them back into my body...


reputo
Regular Member


Date Joined Apr 2010
Total Posts : 26
   Posted 6/9/2010 10:15 AM (GMT -6)   
http://www.prostapath.org/us/us-main.html
Age: 57
Biopsy: June 2009. Gleason Score: 3+3.
Zoladex 10.8 mg subq implant on Nov 2, 2009
da Vinci RRP on March 5, 2010
Pathology: margins clear
6-week post-op PSA .06
April '10, Cialis 10 mg 2xweek, 1/3 of the time results in partial erection
Bladder neck dilation May 2, 2010


Jim is sick
Regular Member


Date Joined Mar 2010
Total Posts : 118
   Posted 6/9/2010 11:59 AM (GMT -6)   
Thanks reputo, I'm not sure if there are additional problems associate with sending slides to Germany. I did find that Bostwick does look for the following Biomarkers, I cut and paste from Bostwick website.

Biomarkers
Biomarkers are used to determine the aggressiveness of cancer. A wealth of clinically useful information is available in even the smallest tissue specimens of the prostate, including biopsies and transurethral resections. Substantial effort has been expanded in the past decade in describing the available factors and determining their predictive value for staging, cancer recurrence and survival.

Proliferating Cell Nuclear Antigen (PCNA)
High PCNA labeling indices may indicate progression of prostate cancer,1,2 and may be an independent prognostic indicator.1

Ki-67 and MIB-1
Recognizes a nuclear antigen present in proliferating cells but absent in resting cells. Ki-67 labeling index may discriminate between organ confined and metastatic cancer.

Microvessel Density (MVD)
Helpful in predicting pathologic stage and patient outcome in prostate cancer.

Bcl-2

Highlights the Bcl-2 protein which functions as a blocker of apoptosis and programmed cell death.
Expression of Bcl-2 is normally restricted to the basal cell layer of the normal and hyperplastic prostatic epithelium.
Overexpression of Bcl-2 is present in high-grade prostatic intraepithelial neoplasia.3,4
p53

Identifies p53 (a regulator of the cell cycle) immunoreactivity in cancer cells.
Most immunohistochemical studies concluded that mutant p53 expression is a late event in localized prostate cancer,6-8 usually present in higher (>7) grade cancer.5,9,10
pP27

The cyclin-dependent kinase inhibitor (p27Kip1) negatively regulates cell proliferation.
Decreased p27Kip1 expression may be an independent predictor for cancer recurrence and long-term survival of prostate cancer.11-14
48, Caucasian, 5' 8", 200lbs, 190lbs, general good health.
PSA: 8-7-09 3.22, 11-13-09 4.25.
Biopsy: 32 cores. 3 cores reveal PCa, 10%, Gleason 3+3=6, T1C.
Diagnosed: 2-12-10.
Current Treatment: Active Surveillance, next appointment Oct. 2010. No meat, no dairy, lots of fruits and vegetables.
Preferred Treatment: I just want someone to harvest my immune cells, genetically engineer them to fight my prostate cancer, and then infuse them back into my body...


Jim is sick
Regular Member


Date Joined Mar 2010
Total Posts : 118
   Posted 6/9/2010 2:47 PM (GMT -6)   
Just got off the phone with Bostwick. Everything is in place. They should have the slides in a few days. I can't believe it took me 2 and a half months to get up the courage to get the second opinion. I'm such a loser. :P I will post the results here when I get them. I just searched my first post and re-read it. JohnT you are truly a smart and caring man. You answered all my questions in the first post. I didn't remember everything, so asked again. Thanks to all for putting up with me.
48, Caucasian, 5' 8", 200lbs, 190lbs, general good health.
PSA: 8-7-09 3.22, 11-13-09 4.25.
Biopsy: 32 cores. 3 cores reveal PCa, 10%, Gleason 3+3=6, T1C.
Diagnosed: 2-12-10.
Current Treatment: Active Surveillance, next appointment Oct. 2010. No meat, no dairy, lots of fruits and vegetables.
Preferred Treatment: I just want someone to harvest my immune cells, genetically engineer them to fight my prostate cancer, and then infuse them back into my body...


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 6/9/2010 3:04 PM (GMT -6)   
Jim, please be sure to let us know the results of the Bostwick lab tests if you don't mind sharing. I was just in your town May 21 thru 23 and don't see how you can stand that heat and humidity of that weekend. If you tolerate that, you deserve a good result in the lab tests.
Bob
Age 73 Retired Railroader.
Dx Jan 2010, Volume 51.345
Gleason 3+4=7, second opinion 4+3=7 (Don't know which to believe)
PSA
2.6 4/96.......... 3.7 4/07
1.9 5/97.......... 3.2 1/08
2.3 4/98.......... 6.1 4/09
2.2 10/99......... 5.3 5/09
2.4 8/00......... 5.3 8/09
2.3 6/01......... 6.9 10/09
2.9 2/03......... 7.3 12/09
3.6 4/04......... 6.1 1/10
3.0 5/05......... 5.0 3/10
4.7 4/06......... 0.7 5/10 (Lupron/Bicalutamide)
Volume study Feb 15, 2010 = about 54cc
On Feb 15, 2010 put on 90 days of Bicalutamide
Got LHRH Lupron shot on Feb 29,2010
Another Volume study May 24, 2010 = in mid-40cc
BRACHYTHERAPY received May 26, 2010
Received 80 I-125 (Iodine seeds)
Activity per seed (mCi) 0.373
Total activity implanted (mCi)29.80
Measured exposure @ 3 feet (mR/hr) 0.06
Received the Brachytherapy at the Chicago Prostate Cancer Center from Dr. Brian Moran
Walked in the facilty and just a few hours later walked right out.
No after effects other than just a little sore from the needle sticks but NOT serious
enough to take ANY meds for pain.
PSA to be taken in three months (Aug 2010).


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6946
   Posted 6/10/2010 7:44 AM (GMT -6)   
I got a four page report from Bostwick. So detailed I still don't understand it all.
New Topic Post Reply Printable Version
Forum Information
Currently it is Monday, June 18, 2018 1:12 PM (GMT -6)
There are a total of 2,972,850 posts in 326,022 threads.
View Active Threads


Who's Online
This forum has 160861 registered members. Please welcome our newest member, Jojoatl.
442 Guest(s), 10 Registered Member(s) are currently online.  Details
California Dreamer, Balladeer, Solaris719, spouse21, Girlie, Sara14, getting by, Aaronh819, cppoly, huneri