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Cancer: Prostate Message Board
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Old 02-01-2011, 12:14 PM   #1
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Biopsy Results

My husbandís biopsy came back negative for cancer. That is good, but I have some problems with it. They only did an 8 core biopsy (5 in the left lobe & three in the right lobe) because that is what the insurance will pay for.

The pathology report says chronic prostatitis. If that is correct the several courses of antibiotics that he was taking last year should have lowered his PSA, if even just slightly & they didnít. And again he has absolutely no symptoms and a PSA of 5.2.

The urologist said to do nothing, have another PSA test next year & dismissed us. When I questioned only taking 8 cores and what to do about his elevated PSA, shouldnít it be monitored every three months & try to lower it with antibiotics, he said no, stood up and left.

We will see his primary care doc next week and see what he says, but I am very concerned about letting this go for another year. If antibiotics lowered his PSA even a little Iíd be more comfortable.

Iíd love to hear any info that anyone has about how the pathologist differentiates between inflammation/prostatitis & early stage cancer. Also, anyone who has had a persistent case of prostatitis and was successful treating it with what type of antibiotics. Iím not borrowing trouble here just am not convinced this biopsy was thorough & waiting a year for another PSA test is scary.

The one good thing is that because he wasnít diagnosed with cancer I have time to get better insurance without a pre-existing condition. This SCAN is absolute carp and only pays for bare minimum and the worst doctors. For now it is a relief to know that I donít have to immediately start fighting the insurance company to get good treatment, but I am not convinced there is no problem.

 
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Old 02-01-2011, 02:12 PM   #2
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Re: Biopsy Results

Early PC generally manifests itself first in a band along the rectum side of the prostate and an 8-core sample done properly would certainly have indicated if there was any reason to go farther. In my case, my early PC showed up in 3 of 12-or to put it another way-in 1/4 of the samples. Had I had an 8-core test done, at least 1-2 would have shown up positive, so there is no way that I would have been misdiagnosed as negative.

How does the pathologist know if it's not cancer? The cells appear normal. I've seen the report on my samples and in the pictures of the samples it's very clear which cells are deformed and are cancerous and which are not. The differences are very obvious. The level of deformity is expressed in the Gleason rating, the higher the number, the more deformed the cells and consequently the more progressed the cancer. If the Pathologist can't find any deformity in the cells then the cause of the elevated PSA is not overactive cancer cells.

As far as elevated PSA goes, let me share with you that I have a friend who had the PC (PSA 5+) scare two years ago just about the time that I was going through it. He had to make the decision whether or not to get biopsied. He chose to wait-his doctor thought that the time/risk was reasonable-and as his luck would have it, his PSA dropped back down to normal after a couple of months on its own. Sometimes the body works in ways we don't understand yet.

Good luck,

Bob

 
Old 02-01-2011, 02:28 PM   #3
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Re: Biopsy Results

Thanks for your input Bob. I am cautiously optimistic, just not entirely convinced. I donít think his PSA is going to go down on its own. It has risen from 3.9 in 2003 to 5.2 in 2010. Antibiotics, so far have had no effect on it.

I will be taking this up with his primary care doctor soon, but I doubt he is current on prostate problems. I am just not comfortable waiting a year before doing anything about it, but neither do I want to make a problem where there is none.

 
Old 02-01-2011, 03:26 PM   #4
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Re: Biopsy Results

Hi Cindy,

Congratulations to you both! I realize you have some lingering doubts, but my take is that the biopsy is giving you a true result. I'll add some thoughts in green to your initial post on your new thread.


[QUOTE=PCaStudent;4674688]My husbandís biopsy came back negative for cancer. That is good, but I have some problems with it. They only did an 8 core biopsy (5 in the left lobe & three in the right lobe) because that is what the insurance will pay for.

I too am convinced now that the biopsy is more reliable with 10 cores or even more, but 8 is still more than the six core biopsies that were standard for many, many years. For instance, mine was a six core biopsy back in December 1999. I'm thinking that an eight core biopsy should be a pretty good indicator.

Quote:
The pathology report says chronic prostatitis.
That's an important finding! It is possible to find evidence of prostatitis in a biopsy, though I don't know much about that. However, as subtle and stealthy as prostatitis can be, that finding surely explains some if not all of the elevated PSA.

Quote:
If that is correct the several courses of antibiotics that he was taking last year should have lowered his PSA, if even just slightly & they didnít. And again he has absolutely no symptoms and a PSA of 5.2.
How about that one course that actually did lower the PSA slightly? That evidence should not be just thrown out; yes, it could be test variance, but it very well may be a completely or mostly true result. It could even be an instance where there was some test variance that would have produced a higher PSA but that was more than offset by the downward influence of the antibiotic. Prostatitis is ofen hard to determine and hard to pin down to a specific germ. It could easily be missed by several types of antibiotics. A successful antibiotic could also be overlooked if it was not continued for sufficiently long. As I recall it, the antibiotic was taken for a fungus and not prostatitis; that makes me think your husband got a side benefit but probably a course of antibiotic that was too short to sharply lower the PSA or cure the prostatitis. As you note, many patients with prostatitis have symptoms, but some do not. Given all the evidence, the doctor's finding of prostatitis seems right, in my somewhat savvy layman's eyes.

Quote:
The urologist said to do nothing, have another PSA test next year & dismissed us. When I questioned only taking 8 cores and what to do about his elevated PSA, shouldnít it be monitored every three months & try to lower it with antibiotics, he said no, stood up and left.

We will see his primary care doc next week and see what he says, but I am very concerned about letting this go for another year. If antibiotics lowered his PSA even a little Iíd be more comfortable.
I would not want to sit on this either. I would try to find a doctor more expert in dealing with prostatitis, and I would want to give that antibiotic that was somewhat successful earlier a longer try, maybe with a higher dosage, if possible. (Sometimes there are limits on how long you can use such medications.)


Quote:
Iíd love to hear any info that anyone has about how the pathologist differentiates between inflammation/prostatitis & early stage cancer.
I just did a quick PubMed search (www.pubmed.gov, a site we can use on this board because it is Government sponsored, for " prostatitis AND biopsy ", without the quotation marks, and with these Limits set: only items with abstracts, Humans, Male, All Adult: 19+ years, Field: MeSH Major Topic . That resulted in 9 hits. You could do the same thing or something similar.

Take a look at this abstract in particular. It's difficult to understand, but I think the main thoughts are somewhat clear about the pathologist's finding prostatitis in the biopsy cores. How about that phony PSA of 114?

Arch Pathol Lab Med. 1997 Jul;121(7):724-9.
Granulomatous prostatitis on needle biopsy.
Oppenheimer JR, Kahane H, Epstein JI.
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Md 21287, USA.



Quote:
Also, anyone who has had a persistent case of prostatitis and was successful treating it with what type of antibiotics. Iím not borrowing trouble here just am not convinced this biopsy was thorough & waiting a year for another PSA test is scary.

The one good thing is that because he wasnít diagnosed with cancer I have time to get better insurance without a pre-existing condition. This SCAN is absolute carp and only pays for bare minimum and the worst doctors. For now it is a relief to know that I donít have to immediately start fighting the insurance company to get good treatment, but I am not convinced there is no problem.
Aw, you're just worried that we won't admit you and your husband to the club.

Take care,

Jim

 
Old 02-01-2011, 04:45 PM   #5
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Re: Biopsy Results

Yes, Jim I am kind of disappointed that we arenít ďrealĒ members yet as there are a really great bunch of people on this board.

Because my husband had no symptoms, I did very little research/reading on prostatitis. I will do that now. PubMed is a great resource. I may find something that will give me a clue to what is going on.

Itís a slow process, but I am going to keep pushing for answers with this elevated PSA. It would just be foolish to let it go for a year. His primary care doc is a good guy and while may not be too knowledgeable about prostate issues, he does listen to me.

 
Old 02-01-2011, 05:35 PM   #6
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Re: Biopsy Results

I hope you will keep posting and sharing your hard won knowledge but will never have to face that positive biopsy.

Take care,

Jim

 
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