Questions about biopsies

[tucker_man]

So I met with another Doc at my treatment center on Friday, he's the rad onc. I discovered that I must have misunderstood the explanation of my biopsy results from my urologist. It turns out that the 7 cores taken of the PI-RADS 4 identified area were benign and the Gleason 6 60% core was found in one of the 12 "blind" biopsy cores that were also taken again during the fusion biopsy. I thought the cancer was found in the PI-RADS 4 area.

To back-up, I had what I call a "blind" biopsy about a year ago. This is where they took 12 needle cores of the prostate, all were negative. My PSA kept rising so they did a 3T MRI a couple months ago and found the PI-RADS 4 area followed by an MRI fusion biopsy with the above results. You guys know that these "blind" biopsies are a stab in the dark (literally). Yes, they take the samples evenly spread out across the posterior part of the prostate, but hitting a small tumor is more luck than anything.

So, in my case, they found cancer in an area, by chance, where they had sampled before and found nothing. How do they get a 60% core of supposed slow-growing Gleason 6 cancer in the same area they got nothing a year before? I know that's not unheard of--lots of patients have multiple negative biopsies before eventually finding cancer. I guess that's what's really bugging me about biopsies when they are just hunting for cancer. The possibility of false negatives is way too high. What I'm worried about is how much other cancer are they not finding? I suppose that's the argument for whole gland treatment rather than localized treatment.

The rad onc is going to send my positive biopsy to get the Oncotype DX done on it. Hopefully this will provide another data point, but that still only tests that one Gleason 6 tissue. What if there's more aggressive cancer tissue elsewhere that the biopsies have missed?

Bottom-line, it seems, is the prognosis relies on how lucky those stabs in the dark are.

[Tall_Allen]

There is a kind of biopsy called a "transperineal template mapping biopsy" where they take 30 or more cores to develop a map of where the cancer is. Consider sending your biopsy slides to Dr Epstein at Johns Hopkins for a second opinion ($250). Oncotype Dx is a good test if you are considering active surveillance, which it sounds like you are a good candidate for.

[GeoffNoLongerAS]

When you compare the size of the biopsies taken against the sizer of the prostate, the samples represent a very very very miniscule sample 0f the prostate. When I had my first biopsy it was not positive (the diagnosis was PIN). It was the second biopsy the identified the cancer.

I have had at least 5 biopsies. One based on color doppler ultrasound, the rage at the time, which was negative. Another was based on an MRI which was also negative. Only two out of the 5 showed cancer.

The suggestion to have the diagnosis biopsies read by another lab is a very good one. IO have had my initial slides read by at least two other labs. Fortunately (I guess) they all agree on the diagnosis. I have known men that have had the gleason scores changed, both up and down. Having another opinion helps when deciding on what to do going forward.

As to Active Surveillance, I am on AS. I was diagnosed 10 years ago at age 59. It took awhile to find a urological practice that understood AS and have been on AS ever since.

Good luck going forward with whatever you decide.