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Dzierga 03-28-2012 04:05 PM

Should I repeat a bioposy?

I was recently diagnosed with prostate cancer. Of the 12 samples taken, one was cancer (Gleason 3+4 =7, involving one third of the sample), one was "rare atypical small acinar proliferation", and the rest were either benign or "non-diagnostic" because "the majority of specimen was deeply adherent to the sponge pad in which it was submitted and did not survive."

My doctor wants to repeat the biopsy to get more information. But since I already know I have cancer, Gleason 7, I'm starting to think I don't need a second biopsy. I am thinking that I am young enough that I should just go ahead and treat, probably with surgery, rather than "watchful waiting."

Other information: my biopsy was triggered by a nodule detected during my annual physical; my PSA is 3.9, up from 2.2 18 months ago; I am 53 years old and otherwise in very good health.

Any thoughts about the advisability of repeating?

Also, was this a botched biopsy, or is this just something that happens from time to time? If the former, I may want a different doctor/hospital to do the repeat.

Tall Allen 03-28-2012 06:16 PM

Re: Should I repeat a bioposy?
Depending on whether there was cancer detected at the base and how much will change the probability that they can do nerve-sparing surgery. It may also possibly show higher grades of cancer and high likelihood of extracapsular penetration which might diminish the likelihood that surgery could be a successful treatment for you.

I recall my samples were immediately preserved in wax, so I'm not sure how sponge could get in it. If it were me, I'd have it re-done at a different place after you've healed, and have it read by a prostate cancer specialty lab. The biopsy pathology report makes a BIG difference as to your treatment options.

- Allen

Dzierga 03-28-2012 06:34 PM

Re: Should I repeat a bioposy?
The cancer was left apex lateral. The base samples were benign, except the "rare atypical small acinar proliferation" -- whatever that is.

Tall Allen 03-28-2012 06:53 PM

Re: Should I repeat a bioposy?
The "rare atypical small acinar proliferation" means they couldn't get a good read on what it is - often it is cancer, often not. It's a strong indicator of a do-over. You don't know the Gleason scores of the missed cores either -- it could change everything.

If the biopsy was painful, you can ask for a nerve block. It's painless and doesn't leave you drowsy like anaesthesia does. I'd wait until I recovered from the last test, though, and make sure you get antibiotics before and after -- lots of bacteria in there.

- Allen

mrmike2009 04-06-2012 10:04 AM

Re: Should I repeat a bioposy?
Since you already know that at least one of the sameples has cancer you know that you have a set of decisions to make - and a lot of information to collect. My Gleason score was 7 and I had CA detected in only 1 of the samples and it was 10% of that sample. I decided on robotic surgery after a lot of discussions with family, friends, and doctors.

Someone above suggested a re-test with another doctor. You might want to look into options for what you might do (in your area) and then go to that medical facility for the second biopsy. You can talk to the specialists there (radiology, surgeons, etc.) to understand your options and then they can recommed if you will need the second biopsy.

As for left, base, etc - I am pretty sure they took 6 samples from each side of the prostate (left/right) and they shoot for top - middle - bottom. I am not sure, but I do not think it makes a difference where the CA is as the prostate is extremely small (size of a walnut) and the samples are taken "blind". I believe the type of surgery they do and what they can "save" has more to do with how bad the CA is. That is what they can tell from a better biospy.

As I said above, there is a lot to process and many options. My guess is there are more options than I had 3 years ago when I had robotic surgery. I consider myself very lucky (and I also had a great surgeon) in that I have recovered and have no lingering problems. Not sure where you live - but if it is a place where you have a choice of hospitals and doctors - take the time to do the research.

One more thing - in my case I had to redo my biopsy as the first one came back negative for CA but positive for HI GRADE PIN (another indicator for CA). They want to wait a couple of months before they do the biopsy again to let things heal. I was also told that I had to wait 3-4 months before my surgery - after the second biopsy (which did show CA).

Mr. Mike

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