01-10-2022, 06:39 AM
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#1 | | Member (male)
Join Date: Dec 2021 Location: Central PA
Posts: 90
| Accuracy of Blind Biospy versus MRI-Fused
So going through my biopsy result...he took samples on a standard grid, it looks like. The first 12 samples...
1 Prostate, L base lat, Needle Biopsy: - Benign prostatic tissue.
2 Prostate, L mid lat, Needle Biopsy - Benign prostatic tissue.
3 Prostate, L apex lat, Needle Biopsy - Benign prostatic tissue.
4 Prostate, L base medial, Needle Biopsy - Benign prostatic tissue.
5 Prostate, L mid medial, Needle Biopsy - Benign prostatic tissue.
6 Prostate, L apex medial, Needle Biopsy - Benign prostatic tissue.
7 Prostate, R base lat, Needle Biopsy - Benign prostatic tissue.
8 Prostate, R mid lat, Needle Biopsy - Benign prostatic tissue.
9 Prostate, R apex lat, Needle Biopsy - Benign prostatic tissue.
10 Prostate, R base medial, Needle Biopsy - Benign prostatic tissue.
11 Prostate, R mid medial, Needle Biopsy - Benign prostatic tissue.
12 Prostate, R apex medial, Needle Biopsy - Benign prostatic tissue.
Then he did the targeted sample with three cores based on the MRI-identified lesion, using the fusion software to blend it with the ultrasound/
13 Prostate, left apex periph zone P4, Needle Biopsy
- Prostatic adenocarcinoma, Gleason score 3+3=6 (grade group 1).
- Carcinoma involves 2 of 3 cores, linear extent 4 mm (70% of core) and 2 mm (15% of core).
So I was kind of wondering if he had just done the standard blind biopsy if he would have found the 3+3=6 cancer. Sure looks like he wouldn't have.
Interesting.
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01-10-2022, 08:27 AM
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#2 | | Senior Veteran (male)
Join Date: Dec 2019
Posts: 599
| Re: Accuracy of Blind Biospy versus MRI-Fused
Not necessarily. The fusion helped.
I will say 12 samples in a normal size prostate test less than 2 or 3 percent of all the tissue or even less. 13 samples in your prostate (3 or 4 times larger tha normal) is much less than that. I was surprised by how few samples where taken and only one where noted by MRI.
The MRI (not as accurate) read a possible 4. So, there is still that.
Belts and suspenders - get a second opinion of the G3+3 sample through Epstein's lab.
__________________
Born 1953;family w/PCa-grandfather, 3 brothers
7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2
3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3
5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, upgraded to G3+4, Tumor vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
7-9-21 PSA less than 0.02; zero club 6yrs
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01-10-2022, 10:48 AM
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#3 | | Member (male)
Join Date: Dec 2021 Location: Central PA
Posts: 90
| Re: Accuracy of Blind Biospy versus MRI-Fused
Quote:
Originally Posted by Prostatefree  ...and only one where noted by MRI. | He took three cores where the MRI showed a lesion, it just was listed at a single batch for analysis. So 15 cores total. I missed that, the first time I read the report.
What in general is the procedure for asking for an external review by Dr. Epstein? I'd like to confirm the 3+3 for sure.
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01-10-2022, 10:56 AM
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#4 | | Senior Veteran (male)
Join Date: Dec 2019
Posts: 599
| Re: Accuracy of Blind Biospy versus MRI-Fused
I haven't done it, but have read on forums like this it was very straight forward. I'd start with your doctor's office and ask them how to go about it.
And I'm glad to hear about the additional samples at the site of the lesion on the MRI. Once you're in there, why not look around?
__________________
Born 1953;family w/PCa-grandfather, 3 brothers
7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2
3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3
5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, upgraded to G3+4, Tumor vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
7-9-21 PSA less than 0.02; zero club 6yrs
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01-10-2022, 02:37 PM
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#5 | | Newbie (male)
Join Date: Jan 2022 Location: Baltimore, MD USA
Posts: 9
| Re: Accuracy of Blind Biospy versus MRI-Fused
Use your favorite search engine for "johns hopkins prostate biopsy second opinion"
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CentralPaDude (01-11-2022)
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01-11-2022, 04:28 AM
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#6 | | Senior Veteran (male)
Join Date: Dec 2019 Location: NC
Posts: 561
| Re: Accuracy of Blind Biospy versus MRI-Fused
It's hard to say--your uro may have deliberately avoided the MRI target with the single core in that zone, since the plan was to take three cores in the target itself.
Keep in mind that a "random" core biopsy is really not random. Abnormal tissue (whether cancer or not) reflects less energy (ultrasound in this case) than healthy tissue because it is less dense. A uro goes after "suspicious" areas going by the shadows seen on the screen. Of course there is no way of knowing if these areas are healthy, atypical, or cancerous at this point. But this does increase the odds slightly.
A single biopsy can miss existing cancer; however, a uro who strongly suspects PCa, especially in light of a continued rising PSA will want the patient to have repeat biopsies. If, for argument's sake, the chance of missing existing cancer with one biopsy is roughly 33%, the chance of, say, three biopsies missing existing cancer is less than 3% (do the math and you can confirm this).
Djin
__________________
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
Dry; ED OK with sildenafil
Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)
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01-12-2022, 06:44 AM
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#7 | | Junior Member (male)
Join Date: Oct 2020 Location: MO
Posts: 34
| Re: Accuracy of Blind Biospy versus MRI-Fused
Here is a link to the second opinion from John Hopkins: https://pathology.jhu.e du/patient-care/second-opinions (remove the spaces)
It has further links on the process.
Dr Epstein changed my diagnosis from 4+3 to 3+4 but added the cribriform pattern. Well worth the $300. (my insurance accepted the claim, but due to them being out-of network it had its own deductible so I had to pay it). Per someone else I added "hold for Dr Epstein" on the request which ensured the expert himself would look at it.
__________________
PSA at 4.2 10/2019
Diagnosed PCa 11/21/2019 small volume 3+3 thus AS
2021 - PSA 4.72
3TmpMRI then fusion biopsy
3+4 in a 7mm lesion , 3+4 nearby, and 3+3 on other side.
Started SBRT 6/2/2021
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01-12-2022, 08:49 AM
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#8 | | Senior Veteran (male)
Join Date: Dec 2019 Location: NC
Posts: 561
| Re: Accuracy of Blind Biospy versus MRI-Fused
If I remember correctly (and assuming things haven't changed since), Dr. Epstein said (I believe this was in a video) that he personally reviews all cases with the exception of the times he's away at conferences, in which case a colleague does the final report. However, Dr. Epstein reviews these cases when he returns and will let you know if he disagrees with the report.
He made two points that I thought important. First, add a note on the submission form to hold for his review if you want it before the report is released and also to be sure to request that your institution send all biopsy slides --sometimes labs do not sent the slides that do not show any pathology in their judgement, but Dr. Epstein does sometimes find PCa in these slides.
Djin
__________________
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
Dry; ED OK with sildenafil
Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)
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