Anybody have two biopsies?

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same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 9/4/2007 7:02 PM (GMT -7)   

     Here is why I ask.  My treatment is being dictated by my aggressive Gleason of 4+4. With a lower Gleason, I could opt for a different treatment.  One month ago my PSA dropped from 6.8 to 5.1.  What if my Gleason may now be lower?  I had my biopsy samples read by two separate hospitals including Dr. Epstein at Johns Hopkins, so I doubt if the reading from three months ago was wrong.  I sure would like to know if it changed.  Has anybody had two biopsies, and if so:

            Were your Gleason scores different on the second reading?

            How many months apart were they done?

            What was the basis that you had a second biopsy?


Walt
 
Born 1940 - 67 yo
PSA 6.9 March '07 to 5.1 July '07
Biopsy 6/5/07
Gleason 4+4


ldoun
New Member


Date Joined Jun 2007
Total Posts : 19
   Posted 9/4/2007 7:54 PM (GMT -7)   
Same_as_u

My PSA at diagnosis was 6.6 with a free PSA of 16% and a gleason of 4+3=7, but at the presurgery PSA was 5.3 but with a 12% free. The free score is an important component in the PSA that is often not reported to the patient. A Free PSA below 20% is a problem indicator and the lower the worse it is. What did your free % do between the two PSA tests?

If I had a Gleason of 8, I would not worry too much about a second biopsy. If another biopsy showed an 8, then you would be the same place and if it was a 9 then it would be worse. I don't personally think a second biopsy will help you much but only delay a decision.
Age 64
5'8" 145#
PSA pre-op 5.2 (12% free)
Gleason 3+4=7
Robotic RP 4/24/07 Dr. Albala, Duke
Post-op- Organ confined Gleason 7
6/18/07 PSA <0.1
10 wk: 0-1 mini pad per day
ED Cialis and VED prescribed


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 9/4/2007 7:59 PM (GMT -7)   
Selmer, many thanks for your painfully honest answer.

I have no idea why a PSA would change; therefore, I have no idea that a Gleason would or would not. From your beautiful logic, I had better treat this on the path I am going for the worst case scenario of 4+4. It just seems so inconsistent that my PSA drops, and my Gleason says aggressive??? You even went to the effort to read my past posts; I appreciate your insight very much.
Walt
 
Born 1940 - 67 yo
PSA 6.9 March '07 to 5.1 July '07
Biopsy 6/5/07
Gleason 4+4


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 9/4/2007 8:17 PM (GMT -7)   
Thanks ldoun,

The delay has been built in with the lead time that it takes to see most of these medical people. I am now on schedule for 9/14 to talk with the radiologist who will hopefully do an IMRT. The best thing I had going is that this is supposed to be a slow acting cancer. The uro who did my biopsy on June 5, said that I should not wait until November. It sure would have been more peace of mind to have completed treatment before now.

My free PSA was 13% in November when my PSa was at its highest of 6.9. It was never printed on my results for my next two PSA readings. I suspect that since the blood tests were ordered by my PCP, he does not focus on that.
Walt
 
Born 1940 - 67 yo
PSA 6.9 March '07 to 5.1 July '07
Biopsy 6/5/07
Gleason 4+4


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 9/4/2007 9:36 PM (GMT -7)   
Hey Walt,

My first fiopsy was inconclusive so I had a second one a month later. It showed cancer and was graded as 3+3. My PSA was 7.1. As soon as the uro said cancer, I said I want it out. One month to the day I had RRP and the patological stage was T2C Gleason 3+4.

I doubt that once cancer is seen in the biopsy if another biopsy will prove anything. Plus healing from the biopsy will delay treatment. Everyone is different but I would not want to mess around with it. One can suffer from analysis paralysis and die from cancer.

Good luck...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 7/18/07 0.00. 
T level on 4/2/07 - 48     On 7/16/07 - 613
Started Tri-Mix on 8/7/07.  .02 ml and 50 mg Viagra.  It works!!!
Next PSA and T tests on 10/17/07
 
"Patience is essential, attitude is everything."
 


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 9/5/2007 5:34 AM (GMT -7)   
Many thanks Jim,

You make an excellent point that I never realized - a biopsy means a delay for healing. After three months I hope not to have any more delays.

Walt
Walt
 
Born 1940 - 67 yo
PSA 6.9 March '07 to 5.1 July '07
Biopsy 6/5/07
Gleason 4+4


Mike A
Regular Member


Date Joined Feb 2007
Total Posts : 213
   Posted 9/5/2007 7:28 AM (GMT -7)   
Walt,
I had two biopsies, but for a different reason. My PSA was up and down for a year, and after several rounds of antibiotics, my first biopsy was negative. When my PSA was up again at my physical a year later, I repeated the process and after more antibiotics, a second biopsy found the cancer. I agree with Jim and think your assesment is correct. I don't think the cancer has gone away, and you certainly don't want a substansial delay in beginning your chosen treatment.
That said, if a second biopsy would ease your mind about a false positive, and if you could get it scheduled right away, a few days wouldn't change the odds very much.
Good Luck Walt, and keep us posted on your progress.
Best,
Mike
June 2005 - Age 53 PSA 4.8 at regular physical
October 2005 - After several rounds of anti-biotics, PSA 5.2 at Urlogist
November 2005 - Biopsy negative
July 2006 - PSA 5.9 at regular Physical
October 2006 - After several more rounds of anti-biotics PSA 8.1
November 2006 - Second biopsy - Positive
December 2006 - Gleason (3+4=7), Tumor T1c, CT Scan and Bone Scan Negative
January 2, 2007 Robotic Prostatectomy, University of Rochester Medical Center - Tumor confined but larger than thought, only one nerve able to be spared. Margins clear.
February 2007 - Three to four pads a day, no erection with viagara.
March 2007 - Down to two pads a day, had first intercourse with Erecaid pump and bands, otherwise still flat tire.
April 2007 - First Post-Surgical PSA 0.02 and a great relief! Down to one pad a day. Still unable to achive erection without pump.
May, 2007 - Still one pad a day, even try a smaller pad on occasion. Slight improvement on the ED.
July, 2007 - Six Month Post-op: PSA 0.04 still Non-Detectable. One small pad/day for a few drops only! No change in ED.
"If patience is a virtue, I feel like the most virtuous guy on the planet!"


same_as_u
Regular Member


Date Joined Mar 2007
Total Posts : 76
   Posted 9/5/2007 8:19 AM (GMT -7)   
Many thanks, Mike.

You summed it up very well. about all my question did was prove how little I know about the broad scope of pc factors. When I first came to this forum, I actually thought that I would have my prostate removed similar to having my appendix taken out. What a shock as I started to learn the differences.
Walt
 
Born 1940 - 67 yo
PSA 6.9 March '07 to 5.1 July '07
Biopsy 6/5/07
Gleason 4+4

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