The only truthful statistical % after reality hit ...

This thread is exactly the kind of thread that brings tears to my eyes and renews my faith in humanity; you guys are beyond special.

Wade, I can add no useful advice other than to say TAKE THIS ADVICE!

These guys have the shoulders to carry you for a while and carry you they will until your feet get back on the ground and trust me... they aren't yet ... explore what they all say and listen to Tall Allen very carefully.

The best thing you did to tackle your cancer... is come here and pit these guys against it.

Paul

Wade,
Yesterday I shot off my mouth in an abrasive manner. I hope some of what I said you take to heart. You will get through this and you will be okay. Things will change but it is not all bad. You will be alive. I pulled my post down as I regretted saying it afterward. I do apologize for the manner in which I spoke. I also apologize for some of what I said. But not all of it. You gotta get your mind right. This site is about support. I was not being very supportive. Hang in there man. You will be okay.

To IT's point...and I didn't see it in your first post....A standard 12 core biopsy samples something like 0.1% or less of the average sized prostate. There is a huge difference between a core that shows 80% of the core as cancerous and 80% of the prostate being cancerous. I look at my own numbers: I had 3/12 positive cores, and the biggest % in a core was (as I recall) around 40%. My post surgery pathology showed 15-20% cancerous. All a high core reading means is that the doctor hit the ugly spot. Nothing more.

The other thing to remember is that if you do have surgery, your post-surgery pathology will be different overall than your biopsy. about 30% of the time, in fact, is your surgical pathology different either in tumor volume or in gleason score than biopsy shows. Thing is, about 1/2 of that 30% is an upgrade (like I had) and the other 1/2 is a downgrade.

Wade, I hope you're crawling off the ledge. Yes, life will be different. The biggest difference, at least to me, was about what was going on between my ears--not about what was going on between my legs. And the part between my ears is way saner, way healthier, way calmer, much more focused on the important stuff than it was before. And THAT, my friend, is a difference to celebrate.

I’ve already posted in response to WadeB’s initial post. I encouraged him—as someone newly diagnosed with a “favorable intermediate-risk” prostate cancer case—to launch his PC “patient education.” We haven’t heard back from WadeB since his initial posting several days ago, but hopefully we will with some of the questions typical of newcomers. His is a case that, despite being “favorable” does likely call for treatment, but would be highly unlikely to ultimately affect his longevity in any way.

There were a couple comments made since my initial posting which might be appropriate to clarify for WadeB (or others), in the spirit of assisting in gathering a good PC patient education.

First, it’s already be clarified here that the % of cancer is on a per-core-sample basis. A biopsy cannot reveal what WadeB wrote: “80% of my prostate has Gleason 3+4=7 adenocarcinoma.” A biopsy report will list the % cancer for each individual core. It is possible that 9 of his cores all had exactly 80% cancer; but we also know that some of his cores were benign. Prostate biopsies are just a sampling, and can be done to target areas which show up either on ultrasound or if assisted with MRI to areas of likely cancer, which of course will cause an outcome bias which prevents meaningful extrapolation of the sample results.

The second clarification is a fine-point…but answers the question a patient with a thorough PC-education might want to know. Exactly how much of the prostate is sampled in a standard prostate biopsy? At the risk of WadeB already saying he’s adverse to statistics, here’s the math:

Today’s prostate biopsies use an 18 gauge needle, which is about the size of lead in a refillable lead pencil. The outside diameter is 1.2mm and the needle’s inside diameter is about 1.0mm; the length is 17mm but the core sample lengths are variable but typically about 15mm.

So, for ONE core sample,

Volume(1) = pi x radius^2 x length = 3.14x0.5mmx0.5mmx15mm = 12mm^3

For a standard 12 core procedure,

Volume(12) = 12mm^3 x 12 = 144mm^3

A “normal” prostate is 30g, or 30,000mm^3. So the percentage of prostate material taken in a standard 12-core biopsy using an 18 gauge needle set is (approximately):

100% x 144mm^3 / 30,000 mm^3 = 0.5%

halbert made the comment that:

halbert said...
A standard 12 core biopsy samples something like 0.1% or less of the average sized prostate

So, while it was off by a factor of about 5, the difference is probably not material for the current discussion. Some folks won't be interested in this level of detail, but for those who want to quote it, here’s the number that can be used going forward.

Post Edited (JackH) : 5/18/2016 9:50:27 AM (GMT-6)