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Old 03-29-2011, 04:46 AM   #1
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Had biopsy - result - what do you think

Hi
I had a biopsy in Feb this year which resulted in an infection -
I had enlarged testicle! Epididymal orchitis secondry to TRUS biopsy - I was in hosp for 4 days!
Results show
cT1c Gleason 3 + 4 carcinoma of the prostate
PSA = 4.9
Significant LUTS currently no treatment
Enlarged prostate 158cc

I am due to see a specialist this week so any comments will be very welcome ASAP!
Also a bit worried about the infection and if it will have any future impact on my body!
Thanks
P

Last edited by pip5636; 03-29-2011 at 04:47 AM.

 
Old 03-29-2011, 02:06 PM   #2
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Re: Had biopsy - result - what do you think

Hi P,

Let me extend my own welcome to you to the Board! I'll insert some thoughts in green from what I've learned about the disease as a now well informed layman but with no enrolled medical education.


Quote:
Originally Posted by pip5636 View Post
Hi
I had a biopsy in Feb this year which resulted in an infection -
I had enlarged testicle! Epididymal orchitis secondry to TRUS biopsy - I was in hosp for 4 days!
I'm sorry for your misfortune. We have had some board participants post about epididymus, and I hope you will get a response about your question.

Quote:
Results show
cT1c Gleason 3 + 4 carcinoma of the prostate
PSA = 4.9
Significant LUTS currently no treatment
Enlarged prostate 158cc
Your biopsy indicates two low-risk characteristics (the clinical stage of T1c is lower than T2b, and the PSA at 4.9 does not exceed 10) and one higher-risk characteristic, the Gleason of 3+4=7. Taken together, that would indicate an intermediate level of risk.

However, your prostate's extremely large size at 158cc is puzzling in view of the PSA of only 4.9. There are research based rules-of-thumb for size and PSA based on healthy cells; one rule, based on, for you, 158cc X0.066 = an estimated healthy production of PSA of 10.4; another rule is to multiply the size by 10%, which would yield an estimate of about 16. As you can see, your PSA is far lower.

That could suggest a tiny volume of cancer, consistent with the cT1c. How many cores were taken, and how many were positive? Was the volume of cancer reported for each positive core? If only a tiny percent of one core were positive, that would be very roughly consistent with the the rules-of-thumb; it would suggest that healthy cells are producing almost all of that PSA.

A less favorable possibility is that there is actually some high grade cancer, especially with a Gleason 8 to 10, that was not found by the sampling done in the biopsy. Gleason 8 to 10 cancer underproduces PSA. Also, there are some truly rare types of prostate cancer that don't produce PSA.

I suggest you ask your doctor about the size versus PSA issue and the possibility of hidden higher grade cancer. Watch his response, and try to see if he is confident. If not, it might be time to get a second opinion.

You can also ask him for a copy of your biopsy report, and you can then check if it contains additional useful information.

Here's a further key point, the Gleason score. That is very important for good decision making, and unless graded by an expert in prostate biopsies, it is often undergraded but occasionally overgraded. If done by a general pathologist, there's a substantial chance that it is somewhat off - extremely likely to be right about having prostate cancer, but substantially likely to be off in the assigned grading. The solution is to get a second opinion from an expert pathologist. Getting that second opinion is common in the US, but I'm not sure how common it would be in the UK.


Quote:
I am due to see a specialist this week so any comments will be very welcome ASAP!
Also a bit worried about the infection and if it will have any future impact on my body!
Thanks
P
Almost all of us in the US first see a urologist (a surgeon) for our post-biopsy review. A vast majority of urologists recommend their specialty, surgery, and often downgrade other approaches. Surgery can be a fine approach for many patients; however, other approaches, especially radiation, have just as good if not superior results to surgery. That was not the case a decade or more ago when radiation docs typically used doses that were too low; now, at least in the US, they have the dose right. At centers of excellence, seeds are an outstanding approach, with seeds plus external beam also working very well for many patients. Some patients do fine with just external beam therapy that employs modern dosing. It is surprising in the US how many urologists have not kept up with the sea change in radiation success. Many will denigrate radiation based on failures that were common more than a decade ago. If you feel comfortable probing that point with a urologist, ask him (or her) if results for radiation would likely be better with a modern dose of external radiation of about 78 to 82 Gray (Gy) as contrasted to the lower doses typically given more than a decade ago. (The answer is emphatically yes, but a lot of surgeons are ignorant on this point that has been thoroughly established by research.) In the US, it is fairly common to get at least one more viewpoint from a radiation doctor who is completely independent of the surgeon. (If the surgeon recommends the radiation doctor, you can expect an endorsement of the surgeon's opinion, which is not helpful. You need to find another source for finding a radiation doctor.)

You did not mention your age or whether you have other serious health concerns. In general, for the "average patient" (which none of us exactly match) with an "intermediate-risk" case like yours, if it stands up under review of the Gleason, major treatment would almost always be appropriate as contrasted with what is known as "active surveillance". However, if you are elderly or have other health concerns, you might want to try low-key measures that would slow down the cancer while you use "active surveillance" to see if the cancer turns more aggressive. Nutrition, diet, supplements, exercise and mild drugs (such as a statin - for the prostate cancer as well as cholesterol) are some tactics that could be helpful.

I hope you will return as you have more questions.

Take care,

Jim

 
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Old 03-29-2011, 02:37 PM   #3
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Re: Had biopsy - result - what do you think

Thanks so much for your reply
By the way I am 74 in June
Your post will help me with questions tomorrow.
10-30pm UK time here so will check out forum before i leave at 9am 2morrrow
a BIG thank you for your reply
P

 
Old 03-29-2011, 03:46 PM   #4
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Re: Had biopsy - result - what do you think?

Jim thanks so much for your reply
Here is more info as printed on my letter. I have tried to send info but it has not been posted - sorry!
Biopsy taken on 22 Feb 2011
Specimens A,C,D, (3 positive out of 6 sites) No of involved cores : 1 positive out of 9 left sided cores. 4 positve out of 9 right sidded cores. Size- The core most involved by tumour (specimen A) has a 5mm segment. This occupies *80% of that single core length. Overall Gleason grade 3+4 = 7 Worst core 3+4 = 7 (specimen A)
Testes
A small reactive hydrocoele is identified
Right epididymal orchitis is suggested
Must get to bed 11-45pm
Thanks
P

 
Old 03-29-2011, 07:34 PM   #5
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Re: Had biopsy - result - what do you think?

Hi again Pip,

Good luck tomorrow, which I guess will be today when you read this in a few hours. I've made that evening/night flight to London and Frankfurt a number of times, and the sun comes up mighty quickly. I'll put another thought or to in green.


Quote:
Originally Posted by pip5636 View Post
Jim thanks so much for your reply You're welcome! Glad to help.
...Biopsy taken on 22 Feb 2011
Specimens A,C,D, (3 positive out of 6 sites) No of involved cores : 1 positive out of 9 left sided cores. 4 positve out of 9 right sidded cores. Size- The core most involved by tumour (specimen A) has a 5mm segment. This occupies *80% of that single core length. Overall Gleason grade 3+4 = 7 Worst core 3+4 = 7 (specimen A)
...P
The additional key information is that you have multiple cores including some cancer on both sides of the prostate, and one core with well over 50% cancer. That's not that unusual or highly risky, but it does add a bit of risk. I'm thinking it's enough added risk that you would not want to try active surveillance, even at age 74, unless you have some other serious health issues (the infection being probably very bothersome, but probably not serious from a survival standpoint). Active surveillance is often a long shot anyway with Gleason 7 cancer anyway, with the patient often wanting to get therapy before long.

While robotic surgery done by experts has extended the age range for surgery upward somewhat from the old bound of 69 or 70, I'm thinking that age 74 is pushing it too much; your tolerance of side effects would be lower. (But I have had no enrolled medical education and of course am not a medical professional, so I may be wrong there.)

Besides, very well done radiation with hormonal therapy for a period in support has results as good as or better than surgery, though size of the prostate may be a problematic issue in your case. Radiation needs to penetrate, and there can be a problem with very large prostates. That would be a question for the doctor; if he's a urologist (a surgeon), he may simply not know; a radiation doctor would know.

Hormonal therapy attacks the cancer wherever it is in the body but sharply reducing its fuel supply (testosterone and DHT, mainly), and size of the prostate is not an issue for hormonal therapy. Hormonal therapy can also shrink down large prostates, often by at least a third, but that might not be enough for radiation. My own therapy for a challenging case has been intermittent triple androgen deprivation therapy (otherwise known as hormonal therapy), with a drug from each of three classes. My main drugs, typical in triple blockade, have been Lupron, Casodex (now generic bicalutamide), and finasteride (the generic version of Proscar for a number of years now). Countering side effects is quite possible to a substantial degree with hormonal therapy, though many doctors are unfamiliar with the fairly simple steps to accomplish that. Also, many doctors do not realize that properly done hormonal therapy can control the cancer for typically more than a decade, after which second line hormonal therapy is possible. That could well gain enough time for patients to enjoy the fruits of dramatic treatment advances that are being made.

Take care and good luck,

Jim

 
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pip5636 (03-31-2011)
Old 03-31-2011, 10:26 AM   #6
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Re: Had biopsy - result - what do you think

Hi
All went well yesterday when I met the surgeon at the hospital.
Thanks to you Bill I was able to ask many quality questions & he was quite frank about my problems but indicated that the cancer threat was not serious!
It seems as I will have the HoLEP method which is the laser op to remove cores from the prostate.
Afterwards psa will be watched & if required radiotherapy will used!
They said the wait to go in will be about 4/5 weeks!
With our Nat Health service it will be free but - waiting can be a long time!
Bill thanks for all your info
P

Last edited by moderator2; 03-31-2011 at 10:53 AM.

 
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