Can a biopsy be wrong?

My husband underwent a 12 needle prostate biopsy in June. The pathology
report came back saying that 2 of the 12 were "highly suspicious for
malignancy." He was given a Gleason score of 6 (3+3) and was told he has
stage T2a cancer. We were in the process of investigating types of treatment,
but in the course of this I kept coming across info that just doesn't seem
consistent with the diagnosis. We got copies of the biopsy as well as other
records back to 2000. The only reason that we can determine that the uro
suggested the biopsy was because my husband has had recurring problems with
brownish tinged (blood) in his semen. He has also had a recurring prostate
infection. These conditions, along with BPH, are noted in his records back
to 2000. It was not because of elevated PSA or enlarged prostate. I made
note of all his PSA's and prostate volume that I could find. In late May his
PSA was 1.2 and his prostate volume was 25 grams and smooth. The highest his
PSA has ever been was a year ago when it was 1.9. His PSA and p-vol were
actually higher about 5 years ago: 1.7 and 30 g. In less than 30 days,
from the May exam to the biopsy in June, the Urologist's report has gone from
a 25 g smooth prostate to "enlarged" (at the time of the biopsy it was shown
to be 29.71 g which is within normal range for him, as well as normal for
anyone). So, my question is how is it possible that in less than 30 days he
goes from a normal, smooth prostate, to one that is classed as enlarged and
with a palpable tumor? (At stage T2 a tumor can be felt during a DRE). We
are now looking at getting another pathologist to look at the biopsy and
possibly another biopsy in a few months. I have also read articles
concerning rectal tissue gathered during the biopsy process which mimics as
prostate cancer. Does anyone one have any information or thoughts on our
situation.
Thanks,
JD

On September 10, JJD wrote:

> We are now looking at getting another pathologist to look at the biopsy and
> possibly another biopsy in a few months. I have also read articles
> concerning rectal tissue gathered during the biopsy process which mimics as
> prostate cancer. Does anyone one have any information or thoughts on our
> situation.

I'd appreciate knowing the source of that information about rectal tissue.

So far as concerns a second opinion on the biopsy, that is always
prudent. The paraffin block and slides can be sent to an expert
pathology lab that specializes in PCa. In enlightened jurisdictions,
those specimens are the property of the patient, although some medics
and local labs have a problem grasping that idea.

The cost is around $350 (or more if additional services are ordered) and
should be covered by insurance.

Here is a list of contacts for expert labs:

Bostwick Laboratories [800] 214-6628
Dianon Laboratories [800] 328-2666 (select 5 for client services)
Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162
David Grignon (Michigan) [313] 745-2520
Jon Oppenheimer (Tennessee) [888] 868-7522
UroCor, Inc. [800] 411-1839

I recommend reading the authoritative website of the Prostate Cancer
Research Institute (PCRI), beginning with the section "Newly Diagnosed" at:
http://prostate-cancer.org/education...ewly_diagnosed
or
http://tinyurl.com/yxljbc

Good luck.

Regards,

Steve J

"Empowerment: taking responsibility for and authority over one's own
outcomes based on education and knowledge of the consequences and
contingencies involved in one's own decisions. This focus provides the
uplifting energy that can sustain in the face of crisis."
--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
"The Empowered Patient's Guide."

Thanks for the info. The article "Rectal Tissue in Prostate Biopsy Specimens
Can Mimic Prostate Cancer" can be found: American Journal of Surgical
Pathology. 30(7):866-870, July 2006. Additionaly, Johns Hopkins "7 Keys to
Treating Prostate Cancer" (pg 4) confirms that "Problems with over-diagnosis
relate to a lot of mimickers of prostate cancer that are viewed under the
microscope. These benign cells closely resemble prostate cancer."
JD

Steve Jordan wrote:
>> We are now looking at getting another pathologist to look at the biopsy and
>> possibly another biopsy in a few months. I have also read articles
>> concerning rectal tissue gathered during the biopsy process which mimics as
>> prostate cancer. Does anyone one have any information or thoughts on our
>> situation.
>
>I'd appreciate knowing the source of that information about rectal tissue.
>
>So far as concerns a second opinion on the biopsy, that is always
>prudent. The paraffin block and slides can be sent to an expert
>pathology lab that specializes in PCa. In enlightened jurisdictions,
>those specimens are the property of the patient, although some medics
>and local labs have a problem grasping that idea.
>
>The cost is around $350 (or more if additional services are ordered) and
>should be covered by insurance.
>
>Here is a list of contacts for expert labs:
>
>Bostwick Laboratories [800] 214-6628
>Dianon Laboratories [800] 328-2666 (select 5 for client services)
>Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162
>David Grignon (Michigan) [313] 745-2520
>Jon Oppenheimer (Tennessee) [888] 868-7522
>UroCor, Inc. [800] 411-1839
>
>I recommend reading the authoritative website of the Prostate Cancer
>Research Institute (PCRI), beginning with the section "Newly Diagnosed" at:
>http://prostate-cancer.org/education...ewly_diagnosed
>or
>http://tinyurl.com/yxljbc
>
>Good luck.
>
>Regards,
>
>Steve J
>
>"Empowerment: taking responsibility for and authority over one's own
>outcomes based on education and knowledge of the consequences and
>contingencies involved in one's own decisions. This focus provides the
>uplifting energy that can sustain in the face of crisis."
>--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
>"The Empowered Patient's Guide."

"JJD" <u37337@uwe> wrote in message news:780a915d9d8a2@uwe...
> My husband underwent a 12 needle prostate biopsy in June. The pathology
> report came back saying that 2 of the 12 were "highly suspicious for
> malignancy." He was given a Gleason score of 6 (3+3) and was told he has
> stage T2a cancer. We were in the process of investigating types of
> treatment,
> but in the course of this I kept coming across info that just doesn't seem
> consistent with the diagnosis. We got copies of the biopsy as well as
> other
> records back to 2000. The only reason that we can determine that the uro
> suggested the biopsy was because my husband has had recurring problems
> with
> brownish tinged (blood) in his semen. He has also had a recurring
> prostate
> infection. These conditions, along with BPH, are noted in his records
> back
> to 2000. It was not because of elevated PSA or enlarged prostate. I
> made
> note of all his PSA's and prostate volume that I could find. In late May
> his
> PSA was 1.2 and his prostate volume was 25 grams and smooth. The highest
> his
> PSA has ever been was a year ago when it was 1.9. His PSA and p-vol were
> actually higher about 5 years ago: 1.7 and 30 g. In less than 30 days,
> from the May exam to the biopsy in June, the Urologist's report has gone
> from
> a 25 g smooth prostate to "enlarged" (at the time of the biopsy it was
> shown
> to be 29.71 g which is within normal range for him, as well as normal for
> anyone). So, my question is how is it possible that in less than 30 days
> he
> goes from a normal, smooth prostate, to one that is classed as enlarged
> and
> with a palpable tumor? (At stage T2 a tumor can be felt during a DRE).
> We
> are now looking at getting another pathologist to look at the biopsy and
> possibly another biopsy in a few months. I have also read articles
> concerning rectal tissue gathered during the biopsy process which mimics
> as
> prostate cancer. Does anyone one have any information or thoughts on our
> situation.
> Thanks,
> JD
>

I'm sorry your husband has cancer, JD. It is my humble opinion that it
would be very difficult to have an amount of tissue be graded as a 3+3=6
Gleason and then be ruled by another pathologist as not being cancer at all.
Remember, Gleason start at 1 and end at 5.

I admit to be confused by the "highly suspicious for malignancy" remark. If
that is written, I would image he is talking about one or more cores that
are pre-cancerous, or maybe Gleason 1 cancer cells.

As to the palpability of a nodule, I don't know how fast it can change. The
doctor who did mine first (a fill-in for my GP) felt nothing. AFTER my PSA
came back 16, my urologist could feel it. I suspect some initially don't
really pay attention to what they are doing up a patient's butt when the PSA
is so low.

However, you will need to make some decisions and some of those decisions
will be based on the pathology, so it is not a bad idea to have the cores
graded by another pathologist.

Please keep in touch.


--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04 (06/12/2007)
Non Illegitimi Carborundum

On Sep 10, 11:47 pm, "JJD" <u37337@uwe> wrote:
> My husband underwent a 12 needle prostate biopsy in June. The pathology
> report came back saying that 2 of the 12 were "highly suspicious for
> malignancy." He was given a Gleason score of 6 (3+3) and was told he has
> stage T2a cancer.

JD, if I were in your hubby's position at this point in time (I can't
because I
am already past the diagnosis stage), do the other steps others
recommend,
AND I would also invetigate the possibility of getting a test via
exprimental cancer
indicator studies. I know of TWO types currently: EPCA-2 and semen-
based HCA
tests. These new tests claim to have 90+ percent accuracy of
detecting PCa,
and most likely be the future of tools for diagnosing PCa.

Thanks Steve. In the past 18 months or so, between 7/05 and 6/07, my husband
has had 5 PSA's and DRE's, done by both his primary care physician and the
urologist. The highest PSA was 1.9 the lowest .8 and p-vol 20 - 29.71 grams,
always smooth and normal until the biopsy report came back. Again, one of
the PSA/DRE's was done on 5/24 and the biopsy on 6/21, so in less than 30
days an extremely slow growning condition seems to have suddenly manfested.
What was more confusing, we took the path report and went to talk to his
primary care doc who said "if it says you have cancer you probably do." Then,
he said "if it was cancer it wouldn't say "suspicious" it would say malignant.
So, you may see that there are some inconsistencies that are unsettling.
JD

Steve Kramer wrote:
>> My husband underwent a 12 needle prostate biopsy in June. The pathology
>> report came back saying that 2 of the 12 were "highly suspicious for
>[quoted text clipped - 38 lines]
>> Thanks,
>> JD
>
>I'm sorry your husband has cancer, JD. It is my humble opinion that it
>would be very difficult to have an amount of tissue be graded as a 3+3=6
>Gleason and then be ruled by another pathologist as not being cancer at all.
>Remember, Gleason start at 1 and end at 5.
>
>I admit to be confused by the "highly suspicious for malignancy" remark. If
>that is written, I would image he is talking about one or more cores that
>are pre-cancerous, or maybe Gleason 1 cancer cells.
>
>As to the palpability of a nodule, I don't know how fast it can change. The
>doctor who did mine first (a fill-in for my GP) felt nothing. AFTER my PSA
>came back 16, my urologist could feel it. I suspect some initially don't
>really pay attention to what they are doing up a patient's butt when the PSA
>is so low.
>
>However, you will need to make some decisions and some of those decisions
>will be based on the pathology, so it is not a bad idea to have the cores
>graded by another pathologist.
>
>Please keep in touch.
>

--
Message posted via MedKB.com
http://www.medkb.com/Uwe/Forums.aspx...board/200709/1

Thanks. I just read an article last night on semen-based HCA. That sounds
interesting. We have a world class teaching hospital here, associated with
the university, and I'm thinking that's where we need to go. Otherwise, all
the urologists are pretty much in the same group as the one my husband's been
seeing. The head of the department was recommended to my husband by a biz
assoc. who had prostate cancer a few years ago. I've been doing some reading
up on him and I think he will be a good next step.
JD

cmdrdata wrote:
>> My husband underwent a 12 needle prostate biopsy in June. The pathology
>> report came back saying that 2 of the 12 were "highly suspicious for
>> malignancy." He was given a Gleason score of 6 (3+3) and was told he has
>> stage T2a cancer.
>
>JD, if I were in your hubby's position at this point in time (I can't
>because I
>am already past the diagnosis stage), do the other steps others
>recommend,
>AND I would also invetigate the possibility of getting a test via
>exprimental cancer
>indicator studies. I know of TWO types currently: EPCA-2 and semen-
>based HCA
>tests. These new tests claim to have 90+ percent accuracy of
>detecting PCa,
>and most likely be the future of tools for diagnosing PCa.

--
Message posted via MedKB.com
http://www.medkb.com/Uwe/Forums.aspx...board/200709/1

"JJD via MedKB.com" <u37337@uwe> wrote in message news:780fc531b8622@uwe...

> Thanks Steve. In the past 18 months or so, between 7/05 and 6/07, my
> husband
> has had 5 PSA's and DRE's, done by both his primary care physician and the
> urologist. The highest PSA was 1.9 the lowest .8 and p-vol 20 - 29.71
> grams,
> always smooth and normal until the biopsy report came back. Again, one of
> the PSA/DRE's was done on 5/24 and the biopsy on 6/21, so in less than 30
> days an extremely slow growning condition seems to have suddenly
> manfested.
> What was more confusing, we took the path report and went to talk to his
> primary care doc who said "if it says you have cancer you probably do."
> Then,
> he said "if it was cancer it wouldn't say "suspicious" it would say
> malignant.
> So, you may see that there are some inconsistencies that are unsettling.


I certainly do! All the double talk and you still don't know. That has to
be worse than knowing.

--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04 (06/12/2007)
Non Illegitimi Carborundum

On September 10, JD replied to my inquiry:

> The article "Rectal Tissue in Prostate Biopsy Specimens
> Can Mimic Prostate Cancer" can be found: American Journal of Surgical
> Pathology. 30(7):866-870, July 2006. Additionaly, Johns Hopkins "7 Keys to
> Treating Prostate Cancer" (pg 4) confirms that "Problems with over-diagnosis
> relate to a lot of mimickers of prostate cancer that are viewed under the
> microscope. These benign cells closely resemble prostate cancer."

The correct title is, “Distorted Rectal Tissue on Prostate Needle
Biopsy: A Mimicker of Prostate Cancer.“ The abstract is at
http://tinyurl.com/2tsdac

What it comes down to is, “Rectal tissue is often seen in needle
biopsies of the prostate gland.” And that, “On rare occasions distorted
rectal glands can mimic prostatic adenocarcinoma...” It appears to me
that a pathologist should be aware of this and prepared to differentiate.

One of the authors of the article is Jonathan I. Epstein, MD, of Johns
Hopkins. He is one of the experts I have listed.

Dr. Epstein is a professor in the Brady Urological Institute at JHU, and
may be an author of the other article JD cited.

If there is concern that such a rare problem exists, I can think of no
better consultant than Dr. Epstein.

Regards,

Steve J

The title I gave "is" correct in the journal I cited. Apparently, there are
several articles in various publications dealing with this subject. Here's
another: "Benign mimickers of prostatic adenocarcinoma" Modern Pathology.
2004 Mar;17 (3) 307 - 315.
JD

Steve Jordan wrote:
>On September 10, JD replied to my inquiry:
>
>> The article "Rectal Tissue in Prostate Biopsy Specimens
>> Can Mimic Prostate Cancer" can be found: American Journal of Surgical
>> Pathology. 30(7):866-870, July 2006. Additionaly, Johns Hopkins "7 Keys to
>> Treating Prostate Cancer" (pg 4) confirms that "Problems with over-diagnosis
>> relate to a lot of mimickers of prostate cancer that are viewed under the
>> microscope. These benign cells closely resemble prostate cancer."
>
>The correct title is, “Distorted Rectal Tissue on Prostate Needle
>Biopsy: A Mimicker of Prostate Cancer.“ The abstract is at
>http://tinyurl.com/2tsdac
>
>What it comes down to is, “Rectal tissue is often seen in needle
>biopsies of the prostate gland.� And that, “On rare occasions distorted
>rectal glands can mimic prostatic adenocarcinoma...� It appears to me
>that a pathologist should be aware of this and prepared to differentiate.
>
>One of the authors of the article is Jonathan I. Epstein, MD, of Johns
>Hopkins. He is one of the experts I have listed.
>
>Dr. Epstein is a professor in the Brady Urological Institute at JHU, and
>may be an author of the other article JD cited.
>
>If there is concern that such a rare problem exists, I can think of no
>better consultant than Dr. Epstein.
>
>Regards,
>
>Steve J

--
Message posted via http://www.medkb.com

In principle biopsy CAN'T be wrong,
it is the doctor who gets it wrong

RR



On Thu, 13 Sep 2007 04:53:37 GMT, "JJD via MedKB.com" <u37337@uwe>
wrote:

>The title I gave "is" correct in the journal I cited. Apparently, there are
>several articles in various publications dealing with this subject. Here's
>another: "Benign mimickers of prostatic adenocarcinoma" Modern Pathology.
>2004 Mar;17 (3) 307 - 315.
>JD
>
>Steve Jordan wrote:
>>On September 10, JD replied to my inquiry:
>>
>>> The article "Rectal Tissue in Prostate Biopsy Specimens
>>> Can Mimic Prostate Cancer" can be found: American Journal of Surgical
>>> Pathology. 30(7):866-870, July 2006. Additionaly, Johns Hopkins "7 Keys to
>>> Treating Prostate Cancer" (pg 4) confirms that "Problems with over-diagnosis
>>> relate to a lot of mimickers of prostate cancer that are viewed under the
>>> microscope. These benign cells closely resemble prostate cancer."
>>
>>The correct title is, “Distorted Rectal Tissue on Prostate Needle
>>Biopsy: A Mimicker of Prostate Cancer.“ The abstract is at
>>http://tinyurl.com/2tsdac
>>
>>What it comes down to is, “Rectal tissue is often seen in needle
>>biopsies of the prostate gland.” And that, “On rare occasions distorted
>>rectal glands can mimic prostatic adenocarcinoma...” It appears to me
>>that a pathologist should be aware of this and prepared to differentiate.
>>
>>One of the authors of the article is Jonathan I. Epstein, MD, of Johns
>>Hopkins. He is one of the experts I have listed.
>>
>>Dr. Epstein is a professor in the Brady Urological Institute at JHU, and
>>may be an author of the other article JD cited.
>>
>>If there is concern that such a rare problem exists, I can think of no
>>better consultant than Dr. Epstein.
>>
>>Regards,
>>
>>Steve J

Exactly!

RR wrote:
>In principle biopsy CAN'T be wrong,
>it is the doctor who gets it wrong
>
>RR
>
>>The title I gave "is" correct in the journal I cited. Apparently, there are
>>several articles in various publications dealing with this subject. Here's
>[quoted text clipped - 32 lines]
>>>
>>>Steve J

--
Message posted via MedKB.com
http://www.medkb.com/Uwe/Forums.aspx...board/200709/1

On September 12, JJD via MedKB.com replied to me:

> The title I gave "is" correct in the journal I cited.

(snip)

Not to put too fine a point on it: If one clicks on the link I provided,
one will see the article in the journal
American Journal of Surgical Pathology. 30(7):866-870, July 2006. This
is the same as JD's citation.

But the title is different.

I recommended consulting Dr. Epstein at JHU, one of the authors. You're
welcome; glad to help.

Regards,

Steve J