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Canadian Guy
New Member


Date Joined Dec 2010
Total Posts : 11
   Posted 2/15/2011 3:11 PM (GMT -6)   
For the past 2 years I have been going for a psa test the first 1 was according to my DR. high. I went for 3 more test about 6 months apart the last test showed it had reached 6 . I was sent for a biopsy in Sept. it showed positive 1 core in 8 with less than 5% cancer. I had a second biopsy done a few weeks ago this report say all cores negative . So I guess my question is with a psa of 6 and the first biopsy showing positive what is going on here .

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 2/15/2011 3:46 PM (GMT -6)   
The most likely implication is that you have a small and localized cancer. A biopsy is a bit of a needle in a haystack kind of thing -- or perhaps "plums in the putting" would be more accurate. With only 8 cores, and not that much cancer, the second biopsy simply didn't hit it.

Of course it's theoretically possible that the first test was a "false positive" due to the slides not being read properly, or the second one is a "false negative". If the biopsies were not done and read at a major cancer center by pathologists with a lot of experience you might want to have the slides sent to a top notch place like hopkins and re-read by an expert. There is a degree of subjectivity involved in reading the slides especially in borderline cases.

But the most likely situation given that you have an elevated PSA and one positive biopsy is that you have a small low grade cancer and the second biopsy is a false negative.

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 2/15/2011 4:10 PM (GMT -6)   
hello fellow Canuck:
- there is a lot of information here at this site you can access - it is at the upper portion of the postings - FAQ's and such ....
- from what you have written - it does sound like small and isolated cancer
- but where exactly and how fast it is growing is the next step in your treatment
- basically , don't panic - time to learn about the prostate, your body - and what you want to do.

-Princess Margaret ( Toronto, Ontario, Canada) has a good site also for prostate cancer information -www.prostatecentre.ca/ - it even has a nifty 3-D rotating prostate pix on its front page - gives a good idea of what the area is like and how it is all affected -
:-)
- I would ask for the doctor to put on one page - your PSA timeline to show how slow or fast the PSA is rising - and go from there..
take care.
hugs
BRONSON

Inspector 13
Regular Member


Date Joined Feb 2011
Total Posts : 181
   Posted 2/15/2011 5:04 PM (GMT -6)   
My biopsy showed one core of twelve with 12%. The pathology report after surgery showed a second area of cancer cells which my doctor said was not unusual in my situation with a badly enlarged prostate. If you have small areas where cancer cells are located then it does become a matter of chance to hit or miss the pockets of cancer. I figure I'm lucky the cancer was found because 1 core of 12 is about 8% of the total tissue examined then about 12% of 8% really wasn't much.

The important thing to remember is that, at worst, your cancer is at a very early stage and you are in a very good spot to be cured. At the one year mark after surgery I have a total of four 0.00 PSA tests. Before surgery, I was 5.19, not a lot different than yours.

BillyMac
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Date Joined Feb 2008
Total Posts : 1858
   Posted 2/15/2011 5:05 PM (GMT -6)   
With 8 samples if a tumour is small it would be easy to miss. The average prostate is perhaps 2-3cm high and 3-4cm wide and when taking 4 needle core samples from each side, top to bottom, you can see how little of the gland is looked at. It is a little hit or miss. Then again, there is also a condition known as vanishing tumour -------- a very few men have had their prostate removed only to find on post-op pathology there was no tumour. It may well be that in the case of a very small tumour in one place the initial needle plug actually took it out. A prostate in most cases will yield a blood PSA of prostate size (in CCs) x 0.066. If the reading is above this, in all probability, there are other causes. Prostatitis, where the gland is inflamed to varying degrees, will cause it to leak more PSA than it should. Tumour, by disrupting the structure of the cells will also cause it to leak more. My feeling is the more cores the better and get them looked at by someone well known in prostate pathology. If the 1 out of 8 with 5% in one core is the true condition then you should be in no rush to take drastic action.
Bill

Post Edited (BillyMac) : 2/15/2011 4:08:21 PM (GMT-7)


tedgard
Regular Member


Date Joined Feb 2008
Total Posts : 104
   Posted 2/15/2011 5:15 PM (GMT -6)   

Canadian Guy,

I hope you don’t mind, but I have a few questions. 

How old are you?

In the past two years, what were the PSA readings each time?  In other words, what is the rate of rise in the PSA?

Has there been any history of prostate cancer in your family history?

Thanks,

Ted.


Diagnosis Results – Oct 31, 2007;
•Age – 53 (turned 54 in Nov 2007)
•PSA is 3.83
•Gleason's Grade - 3+3=6, T1C

Surgery Dec 11, 2007;
•Cancer confirmed on Right mid and Left apex
•Both nerve bundles spared, some damage to the Left bundle.
•30 day PSA, .01
•90 day PSA, .00
•Latest PSA, .12
•ED treatments: Levitra, Cialis, Trimix, Erect Aid pump, Penile Implant on 3/12/2009
•Happy

Canadian Guy
New Member


Date Joined Dec 2010
Total Posts : 11
   Posted 2/15/2011 6:49 PM (GMT -6)   
My age is 58 in the 2 years it had risen 1.4 to make it at a 6 . There is no prostate cancer in the family not even my uncles that I know of. TICKER problems run in my family no cancer yet I would hate to be the first .

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 2/15/2011 6:49 PM (GMT -6)   
This is a fairly common occurrance. Most men over 50 have some insignificant cancer clusters that are not tumors and may never grow into tumors. Because biopsies are just a sample, at times they hit these.
The key thing to find out is the size of your prostate. If the size in cc times 1.5 is less than your psa then it is most likely clinically insignificant and will never hurt you. If your prostate is 40cc X 1.5 = 6, then anything under a 6 psa would be considered insignificant and Active Surveillance would be the best treatment. when they did the biopsy they should have measured the size of your prostate, so ask your doctor.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3742
   Posted 2/15/2011 6:51 PM (GMT -6)   
Some very good information has been posted and I would like to ad this..When a pathologist is looking at a prostate tissue sample, today the first cancerous grade is 3. There can be a very fine line between a Grade 2 (non-cancerous) and a grade 3 (cancerous). This is when having an expert pathologist review the slides and offer a second opinion is so important. You don't want to go through a surgery only to find you did not have cancer....
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

Canadian Guy
New Member


Date Joined Dec 2010
Total Posts : 11
   Posted 2/15/2011 7:23 PM (GMT -6)   
Both biopsy the prostate was measured and both times I was told it was normal in size. My next trip to the DR. is in 6 months so I guess I will have to wait and see I just thought it was strange to have a psa of 6 and the test came back clear I guess it is a wait and see game for now.

tedgard
Regular Member


Date Joined Feb 2008
Total Posts : 104
   Posted 2/15/2011 7:56 PM (GMT -6)   

Canadian Guy,

Thank you for providing the follow up information.

It would appear that you have a right to be concerned about what your next steps should be.  I think the best advice you can follow is that of your Dr, assuming there is some real expertise there in regard to the diagnosing and treating prostate related issues including prostate cancer.

There are a lot of men that are choosing the approach of active surveillance (versus ignoring that the problem and hoping it goes away).

Regardless, if you chose not to take a more aggressive treatment like having surgery, you at least may want to choose to fight this in other ways.  There are a lot of things that can help to slow the growth of prostate cancer like diet, exercise, supplements, etc.

Just be aware that there are some men that chose to wait too long, sometimes they waited only a year or two longer then they should have.  Then, when the do decide to take the more aggressive treatments, the cancer has spread further then they wanted it to.

Also, it is not uncommon for a pathology report after surgery to uncover more cancer then was known before surgery due to the biopsies. 

I am an example of post-surgery surprises.  Before surgery they had only identified cancer in the upper right quadrant of my prostate.  My post prostatectomy pathology report showed that I also had cancer in the lower left apex, which involved that nerve bundle.  That would not have been known until the surgery was done.  As a result, even though all the margins were found to be negative on my pathology report, because the nerve was involved, the prostate cancer cells lined up along the nerve and escaped the prostate witch would also have not been known until over three years after surgery.  Now I am going to go through radiation therapy to kill the reoccurring cancer.

I am wishing you the best, regardless of which road you take in this journey.  Be aware that many prostate cancer experts believe that the younger you are when diagnosed, and with a low grade of cancer, you are best served to take an aggressive approach to remove the cancer sooner than later because this provides you with a far greater chance of a long life cancer free.

Good luck and best wishes,

Ted.


Diagnosis Results – Oct 31, 2007;
•Age – 53 (turned 54 in Nov 2007)
•PSA is 3.83
•Gleason's Grade - 3+3=6, T1C

Surgery Dec 11, 2007;
•Cancer confirmed on Right mid and Left apex
•Both nerve bundles spared, some damage to the Left bundle.
•30 day PSA, .01
•90 day PSA, .00
•Latest PSA, .12
•ED treatments: Levitra, Cialis, Trimix, Erect Aid pump, Penile Implant on 3/12/2009
•Happy

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 2/16/2011 7:51 AM (GMT -6)   
Most people have one, two or three biopsys with the last finding cancer which explasins their rise in psa. In my case the first 12 core missed the cancer, a year later another 12 core got one needle with 10% G7. My guess is I had cancer both times but the second found the needle in the haystack. Since you had a positive, it would seem that you have cancer? But now you are really in a gray area.
Some options are:
-have the slides from the first biopsy read again by a big time cancer center that is considered to be best or one of the best.
-have yet another biopsy but done with color doppler guidance so that questionable areas can be sampled, rather than blind
- have a 12 ,or better a 24 core, biopsy to have a better chance at hitting it if it's there.

Like others have said, your cancer, if that is what it is, is probaly very small. Now, while it is small would be a great time to deal with it rather than waiting till is can be more easily found.
Another way of looking at what has happened, is that you had a 16 core biopsy and one core was positive?

Good luck, Ron

Post Edited (knotreel) : 2/16/2011 6:55:17 AM (GMT-7)


Joko
Regular Member


Date Joined Dec 2010
Total Posts : 119
   Posted 2/16/2011 8:08 AM (GMT -6)   
Hey Canadian Guy, I have very similiar journey as yours. I did the first biopsy 12 samples with nothing found 3 years ago. In January I had a saturation or mapping biopsy done, which is about 40 samples. One sample was postive. I am taking a surveillance approach and will have a PSA done in April.

What was the Gleason score on your one sample. That will give you a good indication of how active the cancer is.

Good luck and keep us informed.
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