help understanding biopsy report

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Perineum
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Date Joined May 2011
Total Posts : 23
   Posted 5/19/2011 10:08 AM (GMT -6)   
1.
"short and fragmented prostatic tissue cores show benign prostatic tissue
with chronic inflammation, atrophic changes and focal basal cell hyperplasia."
- what does it mean?? (chronic inflammation, atrophic changes and focal basal cell hyperplasia)

2.
"Immunostain for p-63 (cores n2, 4, 6) supports morphological diagnosis."
- what is "Immunostain for p-63", what is "morphological diagnosis"???

3.
"Immunohistochemical staining for neuro-endocrine markers is recommended"
- what is it? why is it recommended? how should I do this?

Couldn't find clear explanation no the net...
Could someone please explain with simple words the meaning of there report??

Thanks a lot !!

reachout
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Date Joined May 2009
Total Posts : 725
   Posted 5/19/2011 10:30 AM (GMT -6)   
Wow, maybe someone here knows, but that's pretty clinical stuff. Did it say anything about cancer being found, with a Gleason grade? If not, they probably didn't find anything.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

Perineum
Regular Member


Date Joined May 2011
Total Posts : 23
   Posted 5/19/2011 10:39 AM (GMT -6)   
Full report:

- One of the cores involved by prostatic acinic adenocarcinoma (about 60-70% of this core tissue volume).
- Gleason: 5+4=9/10 and showing prominent signet ring cell carcinoma features.
- Other short and fragmented prostatic tissue cores show benign prostatic tissue
with chronic inflammation, atrophic changes and focal basal cell hyperplasia.
Immunostain for p-63 (cores n2, 4, 6) supports morphological diagnosis.
- The immunohistochemical staining for neuro-endocrine markers is recommended.

reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 5/19/2011 10:47 AM (GMT -6)   
Perineum, from a patient perspective, the key things to note from your report are the 60-70% involvement and Gleason 9/10. The other stuff is important, but is technical and only your doctor can really interpret it for you.

As far as the involvement and Gleason, that is fairly high. As you know, Gleason only goes to 10, and you seem to have a large amount in that core. Doesn't mean it's not curable, or can't be treated by a number of methods, but I really encourage you to get with your urologist at the earliest opportunity and discuss options. With those numbers, to be straight with you, I don't think you have as much time to make decisions as the guys with Gleason 6 or 7.

This is not to alarm you, since my neighbor was Gleason 9, was operated 4 years ago, and is doing fine with 0 PSA. But you need to get with your doctor soon and discuss what to do, because you are fairly well advanced along the Gleason scale.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

Fairwind
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Date Joined Jul 2010
Total Posts : 3744
   Posted 5/19/2011 11:03 AM (GMT -6)   
The only thing YOU need to concern yourself with is the Gleason 9-10 finding...That's bad news.. The good news is that it's confined to one core...

In my opinion (I'm NOT a medical professional) I would be making a treatment decision and getting into treatment as soon as possible....

I am also a G-9...The "Standard" recommended treatment, depending on your age and general overall health, would be surgery to TRY and get it all, quickly followed by adjunct radiation treatment in case they didn't get it all, and maybe boost the effectiveness of the radiation by adding HT to the agenda...That's what I'm doing...

High-risk guys like us need to hit it as hard as we can, as fast as we can...We are indeed in a fight for our lives...No sugar-coated pills, that's just the way it is...It's not hopeless, a fairly high percentage of us are still alive ten years out...

Best of luck to you..
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd 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. 2-15-'11 PSA 0.0

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/19/2011 11:42 AM (GMT -6)   
Did you catch signet ring...
 
(removed the rest of the info....not even a thank you for posting)  cool   

Post Edited (zufus) : 5/20/2011 6:27:25 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/19/2011 11:55 AM (GMT -6)   
fairwind,

to be fair, the one positive core is all the biopsy found, doesn't mean his cancer limited to that one core, might be on the edge of a lot more cancer, its possible.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

English Alf
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Date Joined Oct 2009
Total Posts : 2215
   Posted 5/19/2011 11:59 AM (GMT -6)   
Further to Purgatory's observation that only one core was positive, I haven't seen any mention of the total number of cores, as one positive among 12 is better than one out of six.
And how old are you?

Alf
Age dx 48
Apr 09 PSA 8.6
DRE neg
Biop 2/12 pos
Gleason 3+3
Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
Nov 09 PSA 0.1
Mar 10 PSA 0.4 sent to RT
13 Apr CT
RT 66Gy ends 11 Jun 10
Tired + weird BMs
Sep 10 PSA <0.1
Jan 11 PSA <0.1
Apr 11 PSA <0.1
Erection OK

Perineum
Regular Member


Date Joined May 2011
Total Posts : 23
   Posted 5/19/2011 12:30 PM (GMT -6)   
1 out of 12 cores
age 63
My last PSA is about 9.


What do you suggest? Doctors don't know for sure if it's confined to the prostate or not.
bone scan, CT - negative.


Urologists says I need to wait 3 months after biopsy, then do open surgery. After surgery they will examine prostate and decide further treatment - most probably radiation.
Oncologists disagree, thinks surgery won't cure.

Urologists say they found only one core probably because they didn't see a clear tumor on the biopsy so got random tissues.

Read a lot, but still don't know if surgery is the right decision... Scared to make the wrong decision confused

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5823
   Posted 5/19/2011 1:49 PM (GMT -6)   
Whats this 3 mos after biopsy, do any of these guys know what they are doing? can em, dont even be nice get knew doctors and have them get records, Turn the corner on them, wow that is so upsetting to me. I s this the twilight zone , a new paradign. Even the most ardent apologist for the these guys have to see this is wrong. I need a stiff drink or 2, no Im not an alki, bout to relapse. It is so discouraging. Did I read that right. any one esle see this as a red flag, giant kine
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 5/19/2011 1:58 PM (GMT -6)   
Logo:
 
Actually they do want you to wait at least 6 weeks between biopsy and surgery.
 
3 months is long, given the circumstances, I think
 
Mel

Perineum
Regular Member


Date Joined May 2011
Total Posts : 23
   Posted 5/19/2011 1:59 PM (GMT -6)   
They say that 3 months are needed for the bleeding to recover (caused by the biopsy) - so that the surgery will go well.
They also said that prostate cancer spread slowly and that it was exists a long time (years), so there is no rush in treatment. They said that what's new now is that I know about this...

Is the cancer cell spread rate known for specific GS?
Why are you saying that GS=9 ==> fast treatment?


Thanks !!

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5823
   Posted 5/19/2011 2:13 PM (GMT -6)   
Logo here, I never mentioned any thing about a 9, but do know 10 is as high as they go, so 9 is pretty aggressive. 6-8 is std. 12 weeks seems pretty excessive. It just freaked me, sorry, get a second opinion at least. Didn't mean to scare Perineum. I need a break from the cancer world will be traveling mos of June. Will exercize self control and stay away from forum recharge starting now. Love ya all good, bad and indifferent. Aloha! Logo
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3744
   Posted 5/19/2011 6:01 PM (GMT -6)   
G-9 and G-10 are very aggressive. You get after them as soon as you can. 32,000 men die from PC every year and I suspect the majority of those men were Gleason 8,9,10 Left untreated, it can kill you in 3 or 4 years...

So you treat it as soon as you can, as hard as you can.

I would discuss THIS with your doctors...If you must wait, how about a short period of Hormone Treatment starting NOW to control and suppress the cancer while you are waiting for your prostate to heal..If they say it makes your prostate feel "sticky" I would reply, well, yes, but can't you deal with that?

Is there a REASON they are recommending open surgery over robotic? It makes little difference either way, but I would just like to hear their reasons, since today, 80-90% of prostate surgeries are done roboticly..
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd 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. 2-15-'11 PSA 0.0

Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 5/19/2011 6:25 PM (GMT -6)   
Is it possible they said 3 weeks for healing of biopsy??

Willie is a G9 and had to wait 3 weeks between his biopsy and his surgery.

I sure wouldn't want to be waiting 3 months with a G9 but take some time to get educated about ALL of your options.

Mary.

142
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Date Joined Jan 2010
Total Posts : 6949
   Posted 5/19/2011 6:39 PM (GMT -6)   
8 weeks between biopsy and surgery is the minimum my surgeon waits. For me it was a bit longer because of scheduling.

Casper319
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Date Joined Apr 2011
Total Posts : 771
   Posted 5/19/2011 9:24 PM (GMT -6)   
fairwind.....quick question for you. Are there any differences at all as far as outcome of operation as far as Robotic or open. I know about the longer healing, more painful after and a bigger wound but it would seem to me open works just as well as long as the surgeon is good.

The reason I'm asking is because I was referred to a Dr. in Rochester at the University for robotic surgery only to find later that my insurance doesnt cover out of network providers. I was narrowed down to 3 uroligists that fall in the network and none do the robotic. Only open. The good news is they are local and follow ups will be easier.
Age:50 Diagnosed: April 2011, Age 50
PSA Level 84 Gleason: 8 and 9's
Biopsy results: 10 of 12 tested positive for cancer
Bone scan....negative, CT scans...nagative but
possible spread to seminole vesicles but not confirmed. CT scan showed some rough/blurry areas.

Treatment: Surgery (Date/time still unknown)

Perineum
Regular Member


Date Joined May 2011
Total Posts : 23
   Posted 5/20/2011 1:44 AM (GMT -6)   
Fairwind,

1. I suggested Hormone before the surgery, but they say it will make the surgery difficult.
They are the surgeons.... I want to believe they know what they are saying.

2. They recommended open and not robotic for 3 reasons:
A. My prostate is large - about 90 - so it makes the Robotic surgery difficult.
B. with G9 they want to remove as much as they can (they said also lymph nodes..), which
will be easier with open surgery.
C. In my country (ISRAEL) there is not much experience with the Robotic DaVinci.

I'm not a doctor, although I read every day all day about this thing...
I have no other option but to believe the docs I see...

If the answers they gave me seems to you really unacceptable, please advise..

Thank you all for the support and information. I read this forum all day...

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/20/2011 2:19 PM (GMT -6)   
Contact Lenny Hirsch in Israel, he leads a PCa group, he is a friend of Terry Herberts, Lenny would know your area and knows plenty.
I got his email.   (of course you won't bother replying to this either I guess....have a nice day)  redface
Shalom

Post Edited (zufus) : 5/21/2011 9:01:31 AM (GMT-6)


142
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Date Joined Jan 2010
Total Posts : 6949
   Posted 5/20/2011 2:36 PM (GMT -6)   
Casper,
 
I did DaVinci, but my surgeon was in a practice where they also did open with another surgeon. The differences described to me are those you mention, adding a few more days actually in the hospital as well.

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 5/21/2011 8:26 AM (GMT -6)   
Hi Perineum,

If you are going for surgery you shouldn't worry about the Da Vinci surgery, it only gives you a faster recovery time. What you should be focussed on is getting the cancer out and if it takes you an extra couple of weeks to get over the surgery - well in the scheme of things it's not the important thing I think.

The most important thing by far is the skill of the surgeon. You really want a surgeon who has a good reputation but has done this over and over again. If you get a surgeon who has good statistics and done a thousand open radical prostatectomies that would be ideal. This is a really complex surgery and with Gleason 9 you do not want an inexperienced surgeon cutting through the prostate and the cancer in it. You want a surgeon, who, because he has done this surgery so many times, can tell by feel whether he needs to cut well beyond the boundary of the prostate. The personality of the surgeon is not important, his/her sales technique is not important, the only things that are important are his/her results and his long experience in doing the surgery.

If you are considering other options, a few people with a high Gleason score have gone for combination treatment which includes high dose rate brachytherapy and external beam radiation. To me this makes a lot of sense, brachytherapy involves implanting radioactive seeds into the prostate and then then further zapping the prostate and the area around it. The advantage of brachytherapy is that it does what surgery does by completely destroying the prostate (but with fewer side effects). But the advantage that Brachytherapy has above and beyond surgery is the fact that it also radiates the tissue a few mm beyond the prostate. This means that if there is local spread the Brachytherapy kills two birds with one stone. I know HDR Brachytherapy is available in Australia and the US and just through Google I can see that it's available in Israel as well.

Hope this helps,
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03|Feb11 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01|Feb11 – 0.01|Apr11 – 0.01

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 5/21/2011 8:48 AM (GMT -6)   
Hi Perineum,

As others have said, nine is likey a nasty cancer, but the good news is even though the biopsy may have missed some the other clean cores show it is not all over the place.

If I were you I'd be happy with the advice to pop it out and be done with it.

I'm surprised that the da VInci robot isn't generally used in Israel. Jewish friends have taken us to Israel twice, and on one of these trips we had an extensive tour of the Shaare Zedek hospital in Jerusalem which was a world leader in laprascopic surgery. This was in my pre-PCa days, so I didn't ask about da Vinci. The real issue isn't so much open, or da Vinci, as it is having a surgeon who has, as they say in the OR, "good hands."

Chances are "good hands" means lots of experience, but if you've had a child who plays a violin with a tin ear you'll understand that a lot of practice doesn't necessarily translate into excellence. Use whatever network you can to check out the surgeon. If an OR nurse says they'd lie down on his, or her, table that's good info. If you can talk to nurses on the urology ward they know which surgeons have patients with complications and which don't. All good info if you can get it.

Sorry to welcome you here as it is the club no one wants to join. Nevertheless, welcome.

Please keep us posted as you made your decision.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Perineum
Regular Member


Date Joined May 2011
Total Posts : 23
   Posted 5/21/2011 10:40 AM (GMT -6)   
Hello,

Until the new finding of "signet ring cell carcinoma" the preferred treatment was surgery (Radical Prostatectomy).
But now, I've realized the type of cancer - signet ring - and I need to reevaluate my condition.

I don't really know what it is, but read that it is very rare and graded 5 in Gleason's scale.

Does this new finding (signet ring cell) is important enough to choose a different treatment approach???

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 5/21/2011 10:58 AM (GMT -6)   
Perin:
 
I would think the signet is beyond our knowledge!!
 
Seems that's a good question to ask a GOOD medical oncologist specializing in PC!
 
Mel
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