Contradictory Pathology Reports

Hi!
I wonder if any of you have this experience. Also, what do think is
the best course to get a proper diognosis?
After my biopsy, the pathology report came back with an indication of
cancer giving me a GS of 6, with a PSA of 7.5 and staging of T1c.
While reading "Surviving Prostate Cancer" by Dr. Patrick Walsh, it
suggested that under my circumstances, a second pathology report
should be requested from a different facility. I did this and guess
what? The second report indicates atypical (inconclusive).
So now my operation has been canceled and I am back to square one with
another biopsy this coming Thursday.
Any suggestions? I would appreciate it. How many pathology reports
do we need to get it "right"?

Thanks!

Ernie Adsett

On Jan 14, 1:31 pm, ErnieA <ernieadsett...@gmail.com> wrote:
> Hi!
> I wonder if any of you have this experience. Also, what do think is
> the best course to get a proper diognosis?
> After my biopsy, the pathology report came back with an indication of
> cancer giving me a GS of 6, with a PSA of 7.5 and staging of T1c.
> While reading "Surviving Prostate Cancer" by Dr. Patrick Walsh, it
> suggested that under my circumstances, a second pathology report
> should be requested from a different facility. I did this and guess
> what? The second report indicates atypical (inconclusive).
> So now my operation has been canceled and I am back to square one with
> another biopsy this coming Thursday.
> Any suggestions? I would appreciate it. How many pathology reports
> do we need to get it "right"?
>
> Thanks!
>
> Ernie Adsett

Ernie:
It would be helpful to have more biopsy information to assist in
offering opinions. How many needle cores were taken in the biopsy, how
many were read, how many cores were + for cancer, what amount of each
core was positive for cancer, how close to the margin of each core was
cancer found, was perineural invasion seen, and any other details from
the pathologist report. If you do not have that report, obtain it
before your next decision.. I guess that with a second opinion of
"inconclusive" that means you had a small number/amount/location or
cores. I would not hazard an opinion on a guess. PSA pattern would
also be helpful. Since you were/are cT1 that means unremarkable DRE,
thus found by psa pattern, I assume.
Congratulations on reading the Walsh book,and following that advice.
Usually, with divergent first and second opinions, a third opinion is
recommended, though another biopsy could also help settle your mind.
This time the best possible pathology reader would be in your
interest, and members here can help you locate such a service, if
necessary.

On January 14, Ernie wrote:

(snip re: inconsistent pathology reports)

The reliable reading of pathology specimens is highly dependent upon the
skill of the individual pathologist.

I recommend having the specimens reviewed by an expert in PCa pathology.
Here is a list. They can advise on shipping procedures:

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

Having a reliable path reading is vital.

This, rather than a second biopsy procedure, might be what Walsh refers to.

Regards,

Steve J

ErnieA wrote:
> Hi!
> I wonder if any of you have this experience. Also, what do think is
> the best course to get a proper diognosis?
> After my biopsy, the pathology report came back with an indication of
> cancer giving me a GS of 6, with a PSA of 7.5 and staging of T1c.
> While reading "Surviving Prostate Cancer" by Dr. Patrick Walsh, it
> suggested that under my circumstances, a second pathology report
> should be requested from a different facility. I did this and guess
> what? The second report indicates atypical (inconclusive).
> So now my operation has been canceled and I am back to square one with
> another biopsy this coming Thursday.
> Any suggestions? I would appreciate it. How many pathology reports
> do we need to get it "right"?
>
> Thanks!
>
> Ernie Adsett
You've read I assume what Walsh says about the qualification "atypical",
i.e. for most patients the next step is a repeat biopsy but according to
Epsein, that's of questionable value. His advice is to get a second
opinion. If you apply Walsh' advice to your case, that would mean asking
a third opinion, rather than go through a new biopsy.

"ErnieA" <ernieadsettamt@gmail.com> wrote in message
news:dc56d11c-45d8-4e91-a626-559dcc89723a@s13g2000prd.googlegroups.com...
> Hi!
> I wonder if any of you have this experience. Also, what do think is
> the best course to get a proper diognosis?
> After my biopsy, the pathology report came back with an indication of
> cancer giving me a GS of 6, with a PSA of 7.5 and staging of T1c.
> While reading "Surviving Prostate Cancer" by Dr. Patrick Walsh, it
> suggested that under my circumstances, a second pathology report
> should be requested from a different facility. I did this and guess
> what? The second report indicates atypical (inconclusive).
> So now my operation has been canceled and I am back to square one with
> another biopsy this coming Thursday.
> Any suggestions? I would appreciate it. How many pathology reports
> do we need to get it "right"?

Personally, I think I would trust a conclusive report over an inconclusive
one. But, if the lab was one of the premier labs that Steve Jordan oftens
posts here, then I'd say you are in a bind. I can understand how a lab can
be confused between Gleason 6 and 7, but no about how they can be confused
between cancer and healthy cells. But, then, I've never looked into a
microscope; just seen pictures.

--
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, <0.04 10/11/07
Non Illegitimi Carborundum

Steve Kramer wrote:

>
> Personally, I think I would trust a conclusive report over an inconclusive
> one.

Applied to the facts of this case, Kramer says he rather trusts a report
that may be wrong than a report that says we can't come to a conclusion
because that conclusion is likely to be wrong.



> I can understand how a lab can
> be confused between Gleason 6 and 7, but no about how they can be confused
> between cancer and healthy cells.

What do you think "atypical" means?

>

On Jan 14, 2:45*pm, tarhoos...@carolina.rr.com wrote:
> On Jan 14, 1:31 pm, ErnieA <ernieadsett...@gmail.com> wrote:
>
>
> > Hi!
> > I wonder if any of you have this experience. Also, what do think is
> > the best course to get a proper diognosis?
> > After my biopsy, the pathology report came back with an indication of
> > cancer giving me a GS of 6, with a PSA of 7.5 and staging of T1c.
> > While reading "Surviving Prostate Cancer" by Dr. Patrick Walsh, it
> > suggested that under my circumstances, a second pathology report
> > should be requested from a different facility. I did this and guess
> > what? *The second report indicates atypical (inconclusive).
> > So now my operation has been canceled and I am back to square one with
> > another biopsy this coming Thursday.
> > Any suggestions? *I would appreciate it. *How many pathology reports
> > do we need to get it "right"?
>
> > Thanks!
>
> > Ernie Adsett
>
> Ernie:
> It would be helpful to have more biopsy information to assist in
> offering opinions. How many needle cores were taken in the biopsy, how
> many were read, how many cores were + for cancer, what amount of each
> core was positive for cancer, how close to the margin of each core was
> cancer found, was perineural invasion seen, and any other details from
> the pathologist report. If you do not have that report, obtain it
> before your next decision.. I guess that with a second opinion of
> "inconclusive" that means you had a small number/amount/location or
> cores. I would not hazard an opinion on a guess. PSA pattern would
> also be helpful. Since you were/are cT1 that means unremarkable DRE,
> thus found by psa pattern, I assume.
> Congratulations on reading the Walsh book,and following that advice.
> Usually, with divergent first and second opinions, a third opinion is
> recommended, though another biopsy could also help settle your mind.
> This time the best possible pathology reader would be in your
> interest, and members here can help you locate such a service, if
> necessary.- Hide quoted text -
>
> - Show quoted text -

I appreciate very much the quick response and the listing of top notch
pathology labs given.

Here's the results from the first report. I don't have the second
report other than it was one core and they stated it was atypical.

8 cores taken/ only 1 showing cancer
Core A: core tissue with focal atypical glands. Those atypical
glands have a slightly enlarged nuclei. Focal perineural invasion.
High molecular cytokeratin is negative. right apex: -
adenocarcinoma/ Gleason 3+3=6/10. tumour: approx 3% of the needle
core tissue.
Core B-H: benign prostate tissue.

Also, PSA 2 years ago: 3.5/ Now: 7.5
Unremarkable DRE


Thanks so much!

Ernie

On Jan 14, 11:31*am, ErnieA <ernieadsett...@gmail.com> wrote...snip...

> The second report indicates atypical (inconclusive).

Hi Ernie...The most common kind of prostate cancer is adenocarcinoma.
Often, during pathological examination of prostate biopsy specimens,
the term "atypical" is used to indicate that the cancerous cells are
not adenocarcinoma, but rather other, less common variants such as
small cell, signet, etc. Check with the author of the report and see
what his intended meaning of "atypical" was. Atypical prostatic
tumors need to be treated in ways very different from a normal
prostatic adenocarcinoma...ron

"ErnieA" <ernieadsettamt@gmail.com> wrote in message
news:ff855a55-e2e7-4efd-bb7a-fe29542aada3@e6g2000prf.googlegroups.com...
On Jan 14, 2:45 pm, tarhoos...@carolina.rr.com wrote:

Here's the results from the first report. I don't have the second
report other than it was one core and they stated it was atypical.

8 cores taken/ only 1 showing cancer
Core A: core tissue with focal atypical glands. Those atypical
glands have a slightly enlarged nuclei. Focal perineural invasion.
High molecular cytokeratin is negative. right apex: -
adenocarcinoma/ Gleason 3+3=6/10. tumour: approx 3% of the needle
core tissue.
Core B-H: benign prostate tissue.

Also, PSA 2 years ago: 3.5/ Now: 7.5
Unremarkable DRE

-----------------

It is unfortunate that your doc stopped at eight cores. I didn't think
anyone did less than twelve nowadays.

3% of a needle sure isn't much, is it? Maybe it is hard to determine
cancer, especially from multiple samples.