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B & C
New Member


Date Joined Nov 2006
Total Posts : 13
   Posted 11/28/2006 2:52 PM (GMT -7)   
Hello, my husband has been diagnosed with Prostate cancer. Boy, I hate typing that, it makes it so real.
Billy has-PSA 4.3, Gleason 3&3=6, Negative DRE, one core out of 12 positive less than 5% cancer.
We have been reading a new study by Dr. John Epstein that says with this amount of cancer in the 12 biopsies, it might be beneficial to take Cipro for 4-6 weeks plus NSAID, then have another biopsy. Is there an expert in biopsies? Is having a second biopsy unusual? I have so many questions but this is the one on my mind today.

spinbiscuit
Veteran Member


Date Joined Apr 2006
Total Posts : 818
   Posted 11/28/2006 3:15 PM (GMT -7)   
Hello B & C,

Yes there is, and he is at the Johns Hopkins University Hospital, Baltimore Md. I'm sorry I can't think of his name, but it is mentioned a couple of times in previous posts. He is recognized as one of the foremost authorities in the country at reading biopsies. If you can have him analyze your husband's biopsy; it would probably save time, and a second biopsy.

I'm sure someone will come up with a name, but in the mean time you can Google Johns Hopkins Univ. Hospital and see if you can get some info.

I know this is a very difficult time for both of you, but we will help as much as we can.
Diagnosed at age 60
PSA went from 2.2 to 3.8 in 14 months
2 ot 14 cores positive at 10%
Gleason 6(3+3), negative DRE, neg. boundaries
DaVinci surgery on 02/23/06
 


GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 11/28/2006 3:23 PM (GMT -7)   
Hi, B&C. Sorry to see you here and I know exactly how you feel. Don't know your husband's age, but the scoring is about the same. (1 core positive at 10% at biopsy). Pre-biopsy, husb. took Cipro for 30 days, but that was to see if the initial DRE was indicating an infection. I don't think second biopsies are unusual, but others can speak to that.

Keep reading these threads and all other info you can get your hands on. I do want to say (and please don't be any more alarmed than you are already) that some prostate cancers develop rapidly. As you can see from our path results below that in a three-month period we went from a very nearly innocent biopsy result to full-blown engulfing plus spread. That is not the norm you'll see on this forum, by any means, but I think others here will speak to the point of not waiting too long for treatment if cancer is detected. Others will take a watch and wait stance, which is what many doctors may recommend.

The actual reading of a biopsy is often subjective, too.
Husband age 65
PSA on 5/1/06: 4.2 (had doubled in 13 mos. and rising monthly)
DaVinci Surgery 8/2/06
T2a (at biopsy)
T4c (at pathology) w/cancer cell leakage into fatty tissue
Post-Surgical PSA on 10/3/06 - undetectable!
Update: 11/1/06 - perhaps bladder neck involvement; 30%-50% chance of recurrence
Future: PSA tests twice-yearly for now
 


Jim-N1BRP
Regular Member


Date Joined Jul 2006
Total Posts : 165
   Posted 11/28/2006 4:18 PM (GMT -7)   

The name is Dr. Jonathan Epstein @ Johns Hopkins Hospital

Here is a link to his page

 http://pathology.jhu.edu/N/n.web?EP=N&URL=/MCGI/SEND%5EWEBUTLTY(10326)

 

 

Cost is about $300.00 and may be covered by insurance


Jim, 53, BPH since 1996

Kidney cyst, 2002

Family history of PCa, father and two uncles

Biopsy 18Sept, 10 sample all negative

PSA's                   fPSA

0.7    Sept 01

0.8    Sept 02

1.2    Nov 03

1.3    Nov 04

1.2    Oct  05

3.61  Jul    06

3.2    Aug  06

2.6    Sept 06          19%       


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 11/28/2006 4:42 PM (GMT -7)   
B&C,

Dr. Epstein is the recognized expert in reading biopsy slides. I was somewhat similar to your husband. Same PSA, negative DRE and 1 in 10 core samples at 40% with Gleason 3+3. I sought out a second opinion from Vanderbilt University and they had their pathologist read the slide and he came back with an atypical instead of cancer. My urologist at Vanderbilt then sent it to Dr. Epstein who confirmed the first reading. I would encourage you to seek out a second opinion. The post op pathology on my prostate showed that there was a single tumor located across the mid line in both halves and was about 5% of my prostate. I would see about having the slide sent to Epstein for a second read. My insurance paid for that. If he confirms then the cancer will not go away and you will have to address it at some point. What you have to remember is that the needles used for the biopsy are not that big so they can miss a lot of the cancer. With a Gleason of 3+3 you do have time to research and study before making a decision. The key for you is to know that it has been caught very early and it is curable.

Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
56 Years Old
Post Op Path
Gleason 3+3
Prostate Confined


B & C
New Member


Date Joined Nov 2006
Total Posts : 13
   Posted 11/28/2006 5:24 PM (GMT -7)   
We are so glad we found this board! Thank you all for sharing your experiences, it is invaluable to us "new kids" on the block. Our appointment is with Dr. Patrick Walsh on the 4th of January. I understand he is an expert in prostate cancer, perfecting the nerve sparing surgery. This disease is very frustrating because no one will tell us definitely which is the route to go. I have learned more from this board than any where else.

2busymom
Regular Member


Date Joined Nov 2006
Total Posts : 118
   Posted 11/28/2006 5:40 PM (GMT -7)   
Hi B & C,

The thing that really stinks about cancer is that nothing is a sure thing. I've read posts on this board of men with much higher scores than my husband's that had total containment. My husbands gleason was 3+3, with only 2 out of 12 samples showing cancer, at 3%, both on one side of the prostate. 2 months later the surgery showed the same gleason score, but much more cancer, with some in the margin. The first time we talked to the Dr. he told us that the scores probably wouldn't change in even 6 months, but he warned us that there is sometimes more cancer than the biopsy indicates, and sometimes it's more aggressive. I would follow the advice of the folks here and get that 2nd opinion. And then keep checking the board - the folks here are SO helpful and kind.

becky
husband Jeff 45 years old, diagnosed 8/25/06
PSA 2.1, 2 of 12 samples at 3% & 4%, involving 1 side of prostate
Gleason 3+3=6 in both samples
laparoscopic radical prost. 10/17/06
cancer in both sides of prostate, positive in one area of margin
first PSA in 1/2007


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 11/28/2006 5:58 PM (GMT -7)   
B & C:

If you're going to see Patrick Walsh on Jan. 4, there is no need to ask us any questions. He wrote the book. He'll have the answers to all of your questions, including those about the study which I am not familiar you reference above by his colleague, Jonathan Epstein. If you have surgery, Hopkins' staff is excellent....a finely tuned Rolls Royce is the best way to describe it....and I should know having had surgery there this past August. Walsh and his student, now Director of the Brady Urological Institute and my urological surgeon, Alan Partin, are two experts with experience and exemplar credentials.

Izzyblizzy
Regular Member


Date Joined Oct 2006
Total Posts : 411
   Posted 11/28/2006 7:10 PM (GMT -7)   
Hi B&C,

Our situation is almost exactly the same as yours. We did have a second opinion from Epstein when 5% in one core was found. We started on Avodart, and still have upcoming appointment with a specialist in robotic and another with a dual urologist/oncologist guy. But we have another psa in a bit and perhaps another biopsy six months from his last one depending.

I will be interested in seeing what Dr. Walsh has to say in your case, cause not all of us have access to him! BTW how old is your husband?

Tanya and Ken
Signficant Other diagnosed: 10/30/06 (age 63)
PSA: 3.7 (up from 3.4 prior year)
Gleason: 3+3
Biopsy: 1/10 positive, 5% cancerous, right apex.
Treatment:  Undecided


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 11/28/2006 8:29 PM (GMT -7)   
B/C,

J. Epstein is at John's Hopkins. He is considred one of the worlds leading prostate cancer pathologists. Nice man by the way. He was kind enough to speak with us via land line after doing the second opinion on Paul's slides.
Probably because I bluntly told him I didn't pay for a report reading simply "atypical." After all, he teaches other pathologists that just saying atypical is not appropriate reporting! I think it took him by surprise.

Check out Medscape Urology, prostateline.com and Urology Times for a lot of good information. Many of the reports and articles are writen by some very familiar names. Good Luck to you both.

swim

B & C
New Member


Date Joined Nov 2006
Total Posts : 13
   Posted 11/29/2006 7:28 AM (GMT -7)   
Izzyblizzy,

Billy turned 52 on October 31.

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 11/29/2006 8:46 AM (GMT -7)   

Hi C & Billy,

Sending a warm welcome to both of you…. We are glad you’ve joined us!!!  yeah  

 

The journey with prostate cancer is a journey best traveled with friends….  Thank you for becoming our friends!!  Yes, typing it and saying it out loud ~ gives us that punched in the gut feeling!!  But the more you say it and type it the easier it gets.  The reason is ~ it’s a cancer that can be cured if caught early.  And that’s our ultimate #1goal…Cancer Free, #2 Urinary Continence, #3 Sexual Potency…. In this order.  Now on to the next stepping-stone....  

 

I am really excited to hear about your journey with Dr. Patrick Walsh….  We have his book and we learned so much about this surgery from his book “Dr. Walsh’s Guide to Surviving Prostate Cancer”.  Our urologist recommended this reading……  We went with the (RRP) Radical Retropubic Prostatectomy.  There are many different options to choose from but I agree with SJC 100%.

 

Remember….KNOWLEDGE IS POWER... and POWER conquers FEAR!!!!!

 

Keeping you close in thoughts and prayers,

In New Friendship ~ Lee & Buddy

 

"GOD Bless You"

 

It's a little prayer "GOD Bless You"...

but it means so much each day,

It means may angels guard you

and guide you on your way. 

                                 ~author unknown~

 

 

Sharing ~ Our Personal Threads with new members:  updated  11-17

If you or your loved ones ~  pull “1” thing from our journey that helps you on your journey…… it will truly make our hearts happy!!! 

Our Journey ~ Sharing is Caring, A Special Note for Loved Ones (Wives, Partners, & Caregivers), Give Yourself a Second Opinion, and Murphy ~ Our Special Helper.

To quickest way to find them  is to change the way you look for Threads…  I have mine set at Last Comment.  If you go in and change it to Started By and look for Bluebird (pages 4 & 5 as of Nov-10 ‘06)…. You will find them a lot easier!


mama bluebird - Lee & Buddy… 53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

April 3, 2006   PSA 4.6   Gleason  3+3=6  T2a  

Confined to Prostate   June 29th ~ PSA Less than 0.1 Non-detectable


spinbiscuit
Veteran Member


Date Joined Apr 2006
Total Posts : 818
   Posted 11/30/2006 7:53 AM (GMT -7)   

Hi B & C,

If you have an appointment with Dr. Walsh then you will be meeting with one of the top ranked urologists in the world. I'm guessing that you live in the Baltimore-Washington DC area, and if that is the case you're very fortunate to have access to so many excellent doctors and hospitals. While you are there at Hopkins you may want to speak with Dr. Epstein as well.

Good luck to you on the 4th,

 

 


Diagnosed at age 60
PSA went from 2.2 to 3.8 in 14 months
2 ot 14 cores positive at 10%
Gleason 6(3+3), negative DRE, neg. boundaries
DaVinci surgery on 02/23/06
 


Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 11/30/2006 10:06 AM (GMT -7)   
Hey B & C,
It's good you came here! Lot of good folks w/ alot of experiance. I had a radical prostatectomy at Johns Hopkins over 3 years ago. They were super people, not just the Dr's but all the staff. At the time I was hoping to get Dr. Walsh but he was all booked up for a while. So I was assigned th Dr. Mostwin. I don't know if he is still there but he was Dr. Walsh's personal Urologist at the time and that was good enough for me, plus he had done over 2,000 PC surguries. I could'nt have asked for a more caring and gentle Dr. He really calmed me down and reashured me when I met him. My path report was due back on a Friday afternoon and Dr. Epstein had already left for the weekend. Dr. Mostwin finished his last surgury at about 5:30PM and came to see me. Instead of making me wait untill Monday AM, he went down to the Path. lab and got my results and came back with them before he had even changed his cloths from surgury. He could have just gone home for the weekend to be with his wife who had just given birth to his 1st child, but he didn't want me to have to wait. That's the kind of people who work at J.H.H.
You will be in good hands there!!!
Good luck & keep us updated,
Pete
53 years old, Surgury, Radical Prostatectomy 8/20/03, PSA 6.6, Gleason 3 + 3 = 6, Adenocarcinoma extent (moderate) Stage & Margin:T2NOMX, No Metastases, Organ Confined, bone scan: Neg.  


mickeyboy
Regular Member


Date Joined Nov 2006
Total Posts : 56
   Posted 11/30/2006 11:49 AM (GMT -7)   
Hi B&C, sorry to have to welcome to this forum but i can assure you it will help you with yourtroubles, it certainly has me. It is not unusual to have a second biopsy as in my case i have just had my 4th one yesterday had a total of 51 samples taken from me to date ( im sure they are trying to sneak it out of me in bits so they dont have to operate ) anyway 1 minute they are saying ive got PC 3+3 then the next thing they are saying they cant definately be sure hence the biopsy yesterday, its doing my head in, i was duu for the operation nxt friday but now its been put on hold till we get results.
Im sure yours will turn out ok. Good luck and i hope this has helped you.
Mike ( London UK 48 )

jeb187chs
Regular Member


Date Joined Aug 2006
Total Posts : 62
   Posted 11/30/2006 5:29 PM (GMT -7)   
B&C,

I feel I have to reiterate GreenAcres comments earlier. Some prostate cancer is more aggressive than others and while we don't want to alarm anyone we both had a very bad experience with it. When my PC was first suspected before my biopsy my doctor tried Cipro for several weeks to see if it was an infection or something worse. In hindsight now I wonder what those weeks or months could have meant getting the PC out with surgery before the cancer had penetrated the capsule and had the chance to spread. Biopsies are only as good as the doctor doing them and the ones reading them.

Second opinions are always a good idea, and it sounds like there can be a lot of variation in the way the actual biopsy cores are read. The actual pathology tests on the tissues after surgery may be the only way to be certain how much cancer there is and how much it has spread.

The waiting game for someone as young as you scares the bejesus out of me.

John
Diagnosed Aug. 7, 2006
Age 56
Biopsy 8 of 10 positive
Gleason 8
PSA 16.2
Negative CTscan, bone scan, Carbon 11 PETscan, and lung x-ray
Lapro Prostatectomy 9/7/2006
Capsule penetration, seminal vessicle involvement, clear lymph nodes.
Post op PSA 0.2
95% chance of reoccurance
Hormone and Chemo Therapy on NCI Study CALGB 99904 11/28/06
Followup radiation on about 3/15/07

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