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easyout posted:
Had a biopsee in came back pos.Gl. score of 6.psa 24.6.
When in doubt?
Had a one done in July an came back neg. Showed Doc. first report an he replyed that he didn't know how but said that it was most likely pos.basiced on first report??
Can two biopsee be dif.???
billh99 responded:

Typically, in the early stages, the PC is in small threads or spots. The biopsy needle only samples a very small area.

Get a copy of the first report. Out of 12 different samples maybe only 1 or 2 showed cancer and even then it might be a very small portion of that sample.

I have know people with the opposite. PC suspected and biopsies done for several years before a position results if seen.

If you are really unsure about the first report you can get the slides and have them analyzed by another pathologist.
Basir U Tareen, MD responded:
The answer is yes. The only part of that story that is unusual is the psa of 24.6 -- that is a very high PSA for a supposedly small volume Gleason 6. Either the PSA was high for other reasons (prostatitis? infection? -- have you re-checked it recently) or the disease is understaged on the biopsy.
easyout replied to Basir U Tareen, MD's response:
The Doc. that did the Sec. biopsy didn't do a psa ck an now said that I have to wait for 3 mo.'s after the bispsy to ck. it, they did do a pee sample??? Had a ck up in Jan of 2012 an psa was 10.8 an all lab work showed no disease! Have app. with RAD. doc to start treatment next Thur.???? Any advise???
billh99 replied to easyout's response:
Typically the doctor does not stop in too often. So it might be a month or so before he responds.

Not to put words in the doctors mouth, but it seems that the question is not if PC, but rather if it is low grade or high grade.

Had a ck up in Jan of 2012 an psa was 10.8 an all lab work showed no disease!

Other than the biopsy there is no good test to detect PC. There are several emergent test that look at the blood and/or urine for certain indicators of PC, but AFAIK none of them are ready for use for routine testing.

And while there are ways to image PC that has spread. Imaging PC in the prostrate is very limited. There are a few specialized MRI's that can detect them. But they are not common and I don't know how accurate they are.

Ultra sound is also used. Again I am not sure of the details, but I only think that they will find the larger masses.

The Doc. that did the Sec. biopsy didn't do a psa ck an now said that I have to wait for 3 mo.'s after the bispsy to ck it.

Basically PSA only indicates pressure or irritation of the prostate. An infection, bike ridding, a biopsy, and even having sex before the PSA can cause a false increase.

Was the when you had the first biopsy was the PSA taken before or afterwards?

You can get the slides from the first biopsy reviewed at John Hopkins and maybe Sloan Kettering to see if the assessment of the Gleeson was right.

You might also want to get a 2nd opinion from a local medical school or cancer "institute".

If it is high grade often several treatments are used at once or in sequence. Surgery radiation, multiple radiation (seeds and external), radiation hormone.

Personally, if I had or suspected high grade PC, they I would opt for surgery.

The advantage with surgery they can test the whole prostate and get a much more accurate determination of the grade and amount of PC. Also they can tell if the margins are free of PC and check the lymph nodes.

Here is a too source for information.

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