Advice for Prostate Biopsy Results

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

Corvette Joe
New Member


Date Joined Oct 2017
Total Posts : 14
   Posted 11/25/2017 2:22 PM (GMT -7)   
Hi all,

I had my first biopsy this past Monday. My uro prefers to discuss results in person and not on the phone. I’m scheduled for this meeting Dec 8. Can anyone help me with what I should expect in the discussion and what should I be prepared for or to do/ask? If the Dx is PC or the Dx is Negative, I have no idea what to expect in this discussion. And what is the “whats next”?
Corvette Joe

Age 62
PSA 1/16 @ 2.3; 1/17 @ 3.2; 6/17 @ 3.9; 10/17 @ 4.8
DRE 10/17 Normal
BX 11/17 TBD

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3562
   Posted 11/25/2017 3:04 PM (GMT -7)   
With most uros, if the report is negative for cancer, they usually inform you over the phone...A negative report does not warrant an office visit. A positive report, on the other hand.........But your Uro might be different...If you do have PC, this meeting will be very important as he will spell out in detail what the biopsy revealed and what your treatment options are. I would bring a family member to listen in and take notes as you are not likely to be in a receptive frame of mind..You won't remember the important details...
Age now 75 . Diagnosed G-9 6/2010. RALP, Radiation failed
Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..Sept '17, PSA now 9.2. ADT including Zytiga has failed. Will investigate treatment options. 11/17 PET/CT clear, but 4 new bone mets..Going to try Xtandi and see how I respond to that..

Post Edited (Fairwind) : 11/25/2017 3:19:09 PM (GMT-7)


Froggy88
Regular Member


Date Joined Mar 2017
Total Posts : 52
   Posted 11/25/2017 3:04 PM (GMT -7)   
The topline information is whether any of the biopsy cores came up positive for cancer. If they did, how many were positive, what was the percentage of cancer in each, and what was the Gleason score for each?

If you do test positive for cancer, how you proceed may depend a lot upon the severity of the diagnosis. My guy's practice is to have a follow-up meeting three weeks after presenting the diagnosis to answer questions and consider options. Since I was diagnosed only with what he described as "a whiff of prostate cancer," I was ready to proceed on the spot to active surveillance, and I saved any questions I had for our first surveillance appointment three months later.

One thing you might be prepared to do is to ask for (and insist upon if necessary) a second opinion on the slides from a pathologist who has a particular specialty in reading prostate biopsy slides, such as Jonathan Epstein at Johns Hopkins. (I have to confess that I didn't do this, but I would have if the results had been such that immediate treatment would have been a serious option.)

Another good thing to get in the event of a cancer diagnosis is an idea of the timeframe you have for making decisions regarding treatment. Even with a serious diagnosis that indicates that near-term treatment is warranted, you should have (and should take) the time to catch your breath, and research and consider your options (and talk to various people) before you proceed.

If there's no cancer found in the biopsy you should be getting an idea from your doctor on his idea of what might be causing the PSA rise, and how he wants to proceed from this point on. Is this BPH or something other non-cancerous condition? What does he want to do with regard to further testing (PSA readings, and a possible additional biopsy). What's he ruling out as a possibility, and what's most likely?

Good luck with the results. I'm actually getting my biopsy results a day ahead of you for the follow-up biopsy I had earlier this month.
11/16 DRE+ PSA 3.66
Dx 03/17 (Age 56), 1/14 positive, G6 (5%), T2a
05/17 PSA 1.38; 09/17 PSA 1.47
Currently on AS

Kcheves
Regular Member


Date Joined Apr 2017
Total Posts : 31
   Posted 11/25/2017 3:15 PM (GMT -7)   
All good advice above.

I would add that if you are diagnosed as having PCa, remember that it is not a death sentence. Hearing those words coming out of your Dr's mouth will shake you, but you will quickly move from being diagnosed to having a plan for action. Learn as much as you can so that you can so you can make informed decisions about your treatment. Most urologists will recommend surgery, but make sure you consider all treatment options. Try to slow things down so you can make reasoned decisions.

Of course, we all hope the results are negative. Please come back and let us know how it goes.
Age 54 at dx
Biopsy: 1/5/2017. 2/12 cores positive, PNI+
Gleason score: 3+ 4 = 7 on 2 cores
RALP: 4/6/2107, partial nerve sparing. Dr. Marc Chuang, Kaiser San Diego
Pathology: PT3aR0, G 7 (3+4). Extracapsular extension, margins clear
Dad diagnosed w/ PCa @ age 70, also treated by RALP.

PSA:
8.0 (10/2016)
6.3 (12/9/2016)
<0.1 (5/2017)
<0.1 (10/2016)

Saipan Paradise
Regular Member


Date Joined Sep 2017
Total Posts : 112
   Posted 11/25/2017 3:37 PM (GMT -7)   
Great questions!
A lot will vary depending on your Uro’s style, the biopsy results, and your relationship with the Uro. In my case, he was meeting my wife for the first time and had a bagful of stinky news to deliver, so he started with awkward small talk before dumping the contents of the bag in our laps. He only went over the highlights of the pathology report, then briefly discussed options before strongly recommending surgery.
Instead of worrying about how the visit might go, focus on what you should insist on before you leave the Uro’s office:
—A close, careful, line-by-line review of the pathology report, regardless of whether it showed any PCa. Don’t be satisfied with on overview. Get a copy of the report for your records.
—If PCa, a description of all treatment options, highlighting the pros and cons of each in light of your pathology.
—A treatment recommendation. Keep in mind that Uros are surgeons.
—If PCa, I’d want to talk to a radiation oncologist before making a treatment decision.
—You may want to have your slides sent to a second lab, e.g. Epstein at JH, for another reading. I’m sure others on HW more knowledgeable than I will give you more information about that.
Do your homework on Gleason, staging, and treatment options before Dec 8 so that you can participate meaningfully in the discussion and can recognize if Uro is glossing over something.
I’m a relative newbie to PCa. Listen closely to what the vets may have to say.

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3141
   Posted 11/25/2017 3:41 PM (GMT -7)   
The key things to do are.....
1. take someone with you to listen and take notes. You won't remember everything.
2. Get a hard copy of the written pathology report.
3. Request them to send your slides to Epstein at Johns Hopkins for a second opinion.
4. Don't let your doctor push you into any particular treatment right away. Unless you're a high level, high risk patient (which is relatively uncommon), you don't need to decide on treatment until you have checked out all of the options.
5. Ask your Uro to refer you to his colleagues in other therapies nearby (if you're given a positive Dx)
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4978
   Posted 11/25/2017 4:01 PM (GMT -7)   
You've gotten good information and thorough answers to your questions.
Only thing I'd add, is that it's not unusual for a Uro to always plan on giving the results face to face. The Uro I went to, told me on the day if the biopsy, that I should make an appointment to come back, as his protocol is to have an I. Person discussion on the results whether positive or negative. (My results were negative for cancer, first biopsy). In fact my second biopsy, with a different Uro, and it was positive for cancer, and I was told over the phone , 3 days after the procedure.
So While I don't want to give you false hope, don't jump to conclusions that might lead you down a black hole of fear and panic. Keep your imagination in check.
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margins, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046
Decipher test, low risk, .37 score

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 634
   Posted 11/25/2017 9:05 PM (GMT -7)   
If any cancer is found, do not allow the urologist to pressure you into scheduling surgery. That is the most regretted action among all prostate cancer survivors. Instead, get a printout of the pathology report, and then start your research of all the options available to you. Posting the main data from that report in a signature here will bring helpful guidance. Good luck.
DOB: May 1944
In AS program at Johns Hopkins
Five biopsies from 2009 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
OncotypeDX: 86 percent chance of PCa remaining indolent
August 2015: tests are stable; no MRI or biopsy this year for my AS program
August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA= 26; PHI =28

Post Edited (ASAdvocate) : 11/26/2017 6:57:37 AM (GMT-7)


Corvette Joe
New Member


Date Joined Oct 2017
Total Posts : 14
   Posted 11/25/2017 11:38 PM (GMT -7)   
Everyone, thank you! This is great input and I feel more prepared now. You are just great people.
Corvette Joe

Age 62
PSA 1/16 @ 2.3; 1/17 @ 3.2; 6/17 @ 3.9; 10/17 @ 4.8
DRE 10/17 Normal
BX 11/17 TBD

John_TX
Veteran Member


Date Joined Jan 2015
Total Posts : 897
   Posted 11/26/2017 7:15 AM (GMT -7)   
ASAdvocate said...
If any cancer is found, do not allow the urologist to pressure you into scheduling surgery. That is the most regretted action among all prostate cancer survivors. Instead, get a printout of the pathology report, and then start your research of all the options available to you. Posting the main data from that report in a signature here will bring helpful guidance. Good luck.

What the other guys said. This response from ASAdvocate more or less sums it up, listen to the doc, take notes but consider this the beginning step in your journey if the result is some grade of PCa.
DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
10/2017 PSA < 0.1
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

Paulsch
New Member


Date Joined Feb 2015
Total Posts : 16
   Posted 11/26/2017 10:14 AM (GMT -7)   
Joe you are getting sound advice. Either way I’d bet your dr, wants to sit and explain the results...the week wait sucks,...I have done it twice and possibly a 3rd time coming up. I think the word “cancer” numbs us. Don’t get ahead of yourself but also remember that IF and that’s a big if...they find anything you are in good health and will be cured...
Lots of options and just keep reaching out with any questions or concerns,,,,fingers crossed that it’s just prostitis or bph.

joh3
New Member


Date Joined Nov 2017
Total Posts : 1
   Posted 11/28/2017 1:23 AM (GMT -7)   
I’m a young chap of 76 and all my life kept sexually regular (2-3x p.w.), but then after my wife died I built myself a DIY (Venus 2000 type of) machine, which allowed me to continue enjoying sexual regularity. (See my DIY trials/errors on Youtube: Venus 2000 DIY )
A blood test result showed that my PSA is high (6.1ug/L), thus my doctor recommended a prostate biopsy and now I’m waiting for the result. I don’t fear a negative result, for I urinate like a young chap: i.e. quite strong/ painless and feel otherwise great in every way. The doctor suggested a diet change and regular exercise, but since I already enjoy healthy diet, I only modified the latter to regular sexercise. –I truly believe that stagnant fluids in the prostate allow bacteria to produce the cancer. Since my good doctor disapproves my “use it or lose it” theory, I’m afraid that he himself might well end up with a positive biopsy result.

Corvette Joe
New Member


Date Joined Oct 2017
Total Posts : 14
   Posted 12/6/2017 9:26 AM (GMT -7)   
Thanks again everyone. I put the list of questions together below based on what everyone suggested for my results review meeting with the Uro. Thought I would share it. I get my results on Friday this week.

I live in the Baltimore Washington area. If my results are positive, I would welcome any recommendations in this area for the various treatment options. Also, if there is a "THE" place to go for treatment, I would welcome your thoughts. Hopefully, I'm getting ahead of myself.....but I like to be prepared.

What to expect:
Dr. will spell out in detail what the biopsy revealed and what your treatment options are. Regardless of results, request a line by line review of the pathology report.

Positive Results
• Did any biopsy cores came up positive for cancer?
• How many were positive?
• What was the percentage of cancer in each?
• What was the Gleason score for each and staging?
• What is the severity of the diagnosis?
• What treatment options do you recommend?
• What are the pros and cons based upon my specific pathology report?
• What is the timeframe I have for making decisions regarding treatment?
• I would like to have a follow up visit in a few weeks to ask more questions and consider options.
• I would like your help in getting my slides reviewed by Dr Jonathan Epstein at Johns Hopkins.
• Do you have recommendations on where I can research my options?
• Can you recommend a radiation oncologist that performs SBRT and other radiation treatment options?
• May I have a copy of my report?


If negative results:
• What might be causing the PSA rise?
• Is this BPH or something other non-cancerous condition?
• What's are you ruling out as a possibility, and what's most likely?
• How should I proceed from this point on?
• What do you want to do with regard to further testing (PSA readings, and a possible additional biopsy).
Corvette Joe

Age 62
PSA 1/16 @ 2.3; 1/17 @ 3.2; 6/17 @ 3.9; 10/17 @ 4.8
DRE 10/17 Normal
BX 11/17 TBD

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4039
   Posted 12/7/2017 7:24 AM (GMT -7)   
Corvette Joe, looks like you have a great list of question to ask. You meeting is tomorrow and we will be waiting for your report. The guys have given you some great advise.

On a side note. What kind of Vettte do you have. My screen name has been changed to Cajun Jeff at the request of some of the guys on HW but my former screen name was Corvetteman3. Yep Im a vette guy as well. I am still driving my 2001 vette that I purchased in 2003. I had an 89 coupe and 90 vert at the same time, also had a 77. Love those plastic cars. smile

Best of luck with you visit.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2538
   Posted 12/7/2017 7:59 AM (GMT -7)   
Good luck Corvette Joe--you're well-prepared. All I'll add is that my uro also would always schedule an office review since even if the biopsy wasn't positive, he wanted to discuss next steps. Let us know what happens!
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

Dogdays
Regular Member


Date Joined Jan 2017
Total Posts : 124
   Posted 12/7/2017 8:05 AM (GMT -7)   
Corvette Joe,
I can only echo the excellent advice these guys have already given you. The main thing is to take a deep breath and relax. If the results are positive for Pca, in most cases, you have plenty of time to make your decision. Take that time. And if the news comes back as negative for Pca, go have a beverage of choice and celebrate. Just be sure to let us know. And dont forget to take someone with you for your office visit. Either to takes notes or to join in on the celebration.
Best of luck
Age at Dx. 63
PSA 1/08 1.4, 12/16 12.17, 4/17 3.8, 7/17 1.05, 10/17 <.05 (HT)
GS 9 (4+5)
CT Scan and bone scan 1/17 both negative
2/2/17 prostate MRI.
2/27/17 pelvic bone biopsy done. No mets
3/7/17 Started HT. Degarelix, 4/17 lupron (1-2 years)
7/7/17 LDR Brachy (Zelefsky MSK)
8/25/17 SHARP (SBRT) finished at MSK

Corvette Joe
New Member


Date Joined Oct 2017
Total Posts : 14
   Posted 12/9/2017 5:00 PM (GMT -7)   
Cajun Jeff said...
Corvette Joe, looks like you have a great list of question to ask. You meeting is tomorrow and we will be waiting for your report. The guys have given you some great advise.

On a side note. What kind of Vettte do you have. My screen name has been changed to Cajun Jeff at the request of some of the guys on HW but my former screen name was Corvetteman3. Yep Im a vette guy as well. I am still driving my 2001 vette that I purchased in 2003. I had an 89 coupe and 90 vert at the same time, also had a 77. Love those plastic cars. smile

Best of luck with you visit.

Cajun Jeff


Jeff, I have a 2006 an love it. Looking forward to seeing the mid engine coming out.
New Topic Post Reply Printable Version
Forum Information
Currently it is Saturday, December 16, 2017 4:28 AM (GMT -7)
There are a total of 2,906,039 posts in 318,914 threads.
View Active Threads


Who's Online
This forum has 158257 registered members. Please welcome our newest member, hfttfhtfdsa1.
211 Guest(s), 4 Registered Member(s) are currently online.  Details
Irishlymie, 3timechamp, ExplosiveKittens, randynoguts