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First biopsy results today. Advice?

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Prostate Cancer
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Posted 9/24/2015 9:03 PM (GMT -5)
Today I met with dr for review of first biopsy
I'm 58. Psa 5/15-5.9. 7-15. 6.2
14 cores. 1 poss 3+3. Adenocarcinoma 7% Of surface area
Prostate size 62
Wants me back for psa in 6 weeks and Mri
I'm reading as much as possible any advice appreciated . Thanks I'm very new to all this.
Posted 9/24/2015 9:10 PM (GMT -5)
With just one of 14 positive, I would have your biopsy slides sent to one of the 2 expert labs for a second opinion..You need to be SURE your results are correct before you base a treatment program on them...
Posted 9/24/2015 9:13 PM (GMT -5)
They are on way to jh
Posted 9/24/2015 9:49 PM (GMT -5)
Not only just one cre positive and G6, but only 7% of core is cancer. If that holds after the second opinion at JH, you've got a world f options including AS (if you are good with it mentally)
Posted 9/24/2015 10:20 PM (GMT -5)
Sample was also sent out for an oncotype test ?
Posted 9/24/2015 10:36 PM (GMT -5)
Active Surveillance seems to me a very good option. A G6 in one core is a perfect setup for AS.
Posted 9/25/2015 4:49 AM (GMT -5)
Sounds like you're very much on top of it Jimbo.

Sorry you have to be here and keep us posted.

Dave
Posted 9/25/2015 5:36 AM (GMT -5)
Jimbo, if the results hold up by JHU then AS would be a likely choice for you. I recommend you go back and read some of the recent AS threads here as they have a ton of info and are very encouraging for any man considering that option.

Jim
Posted 9/25/2015 7:13 AM (GMT -5)
At this point you appear to be very low risk. Good job on catching it early. If only we were all so lucky.
Posted 9/25/2015 8:30 AM (GMT -5)
I would be more worried that the bx missed the real cancer..the odds are 25 -30 % about the same odds that Epstein's lab will disagree with the initial pathology .
Posted 9/25/2015 11:11 AM (GMT -5)
That's good news, even though you may not think so at this time. Your psa density is 1 and experts start to be concerned when it goes over 1.5.
a G6, 1 core <7% core, psa density 1 is about as good as it gets in the PC world without not being cancer.
Please read "Invasion of the Prostate Snatchers" by Dr Mark Scholz as it is the best at explaining low risk cancer. Read all you can on Active Surveillance, especially articles by Dr Lawrence Klotz who has the best and longest data on AS patients.
i would normally wish you good luck, but you don't need it at this point.
Posted 9/25/2015 12:40 PM (GMT -5)
Sorry to hear about this, but as other have pointed out this is a very little amount of a very non-aggressive type of cancer. (Assuming your second opinion concurs.) I'd guess a significant number of guys in their 50s and 60s are walking around with more cancer than this, and just don't know about it.

I would really consider Active Surveillance with this type of diagnosis--no sense in upsetting the apple cart over this. Best case, they keep monitoring and your condition doesn't significantly change and you never have to have it treated. Worst case is they monitor it and sometime in the near or far future, they decide to treat it then. In that case you've bought yourself a number of SE-free years and any potential treatments are only going to get better over time. If you do choose to treat it (which would be the equivalent of an elective procedure in your case), anything should do the trick so your focus needs to be on which set of SEs you can best live with since they all more or less have them.

I know no one wants to hear they have cancer, but this is one that you should be able to live with.
Posted 9/25/2015 4:13 PM (GMT -5)
With reference to my earlier post ...Why are you guys hell bent on a second opinion from another group of pathologists with a 20-30 percent change of them disagreeing with the initial pathology but are not the slightest bit concerned about the equal possibility that the biopsy finding only one positive core in particular might have missed the cancer entirely?
Posted 9/25/2015 4:46 PM (GMT -5)
Jimbo58 has to work with what he's got and it totally make sense to get a second opinion on that. And the second opinion he's sending it for is the pathologist that is arguably the best person in the country at reading prostate biopsy slides. Why would he not want to do that?

Re whether or not his biopsy has missed cancer can only be definitively known if he has surgery. If he does AS, he does have more biopsies in his future.
Posted 9/25/2015 5:14 PM (GMT -5)
Sheepguy,

If Jimbo58 and/or his doctors are concerned with possibly missing more cancer, my suggestion would be that he have a 3T mpMRI, which has a success rate of 97 percent or higher in finding prostate cancer lesions. That, in my opinion, is far preferable to having more random biopsies at this time.
Posted 9/25/2015 5:17 PM (GMT -5)
Sheepguy has a point. I read somewhere that traditional biopsy miss between 20 and 40 % of cancer. I have a friend that repeated biopsy three times before they found his cancer.
about second opinions, how to tell which opinion to trust? Should we play safe a trust the most negative opinion. Or trust the most skilled pathologist, but then we don't need a second opinion from a less skilled.
Posted 9/25/2015 5:20 PM (GMT -5)
97% chance of finding PC? That's pretty darned high. Particularly in light of the many institutions doing it.
That means it has a sensitivity of 97%...what , given that , is the specificity ?
Posted 9/25/2015 5:23 PM (GMT -5)
... and beyond that.... who are the good MRI "readers" who set the standard like epstein, et al are said to set for reading biopsies? Are there any? I suppose at some point someone will pipe up and say "I disagree with 30% of the reading of the MRI at instituitions other than my own"...but are there any now? MRI can't be so easy to read that anyone can do it..can it?
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