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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005Atypia Biopsy Results
I'm a 56 yo male and I've been diagnosed with an enlarged prostate for about 3 years now. I have been seeing an urologist and having my PSA monitored since the diagnosis, and the PSA has been 2.42, 2.65, 2.59, and then it rose to 3.58 in my most recent test 2 weeks ago. I've had 3 separate biopsies taken (8 or so samples with each one) in the past 2 years, and they have come back negative, however, I was told today that the biopsy taken last week had "Atypia glands" which could possibly indicate cancer present but not detected in the biopsy. My Urologist prescribed another PSA check in 3 months. I'm wondering if anyone has any experience with a similar type situation? I'm a bit anxious about waiting for 3 months and whether or not I should get a second opinion or maybe an immediate additional biopsy with more than 8 samples taken? Any comments or suggestions are greatly appreciated and thank you in advance. Mine was cancerous but not enlarged, so all I can do is make a dumb observation and hope it helps. Since the gland is enlarged, it is atypical, so "Atypia glands" sounds like exactly what you would get from the biopsy of a noncancerous prostate gland. Sounds like the doctor has diagnosed benign prostatic hyperplasia. Considering the nature of this support group, you know I'm not being sarcastic when I say "Congratulations". jimhoney not a doctor > I'm a 56 yo male and I've been diagnosed with an enlarged prostate > for about 3 years now. I have been seeing an urologist and having my [quoted text clipped - 10 lines] > 8 samples taken? Any comments or suggestions are greatly appreciated > and thank you in advance. I had a similar situation as you have now. I was ultimately diagnosed with PCa and had an RRP. In my case Atypia was seen on the first 8 needle biopsy and was of very little concern to my uro who said " We used to think this indicated imminent PCA but we no longer think that" so we watched and monitored the PSA. As the Psa increased slowly for about 2 years. We did a couple of rounds of antibiotics to see if we were dealing with prostatitis. Got some insignificant decreases in PSA and so I underwent a second biopsy with 12 neddles. That one showed PCA. Has your URO eliminated Prostatitis? People in this group talk about velocity ( the rate of increase in PSA) I dont fully uunderstand it and maybe someone will comment as your PSA history doesnot seem to me to a rapid rate. I could be very wrong however Here comes the disclaimer... I am not a doctor just a user. > I had a similar situation as you have now. I was ultimately diagnosed > with PCa and had an RRP. In my case Atypia was seen on the first 8 [quoted text clipped - 12 lines] > history doesnot seem to me to a rapid rate. I could be very wrong > however The current rule is that if PSA increases faster than 0.75 ng/ml per year over a two year period, then there should be a followup, probably a biopsy. His increase was about 1.0 ng/ml presumably in one year. But there was a biopsy in this case, which didn't find cancer. Recent research suggests that men who had an increase of more than 2.0 ng/ml in the year before diagnosis were more likely to have recurrences after treatment. It seems to me that his urologist is probably monitoring the situation properly under the circumstances. Even aggressive prostate cancers don't orfinarily grow that fast. So, given no cancer was found in the previous biopsy, 3 months may well be a reasonable wait for the next biopsy. > Here comes the disclaimer... I am not a doctor just a user. Anxiety is something that this group can relate to! Your PSA spike could be caused by lots of things (infection in or around the prostate, ejaculation, prostate cancer, etc.). Since total PSA in the blood has a half life of 1-3 days, your PSA should return to baseline within 4 weeks if some transient, non-cancerous event was affecting the PSA. There are also areas of the prostate where PCa can occur, that cannot be sampled or are not sampled thoroughly during routine trans-rectal biopsy. There are a few specialists that use alternate imaging techniques (color doppler, MRI) to better survey the prostate. If they "see" something than they usually perform a "targeted" biopsy and sample the region of interest. These specialists are: Duke K. Bahn MD Medical Director, Department of Radiology Prostate Institute of America Community Memorial Hospital of San Buenaventura 168 N. Brent Street, Suite 402 Ventura, CA 93003 888-234-0004 805-585-3082 Fax: 805-641-3965 dkbahn@cmhhospital.org Fred Lee, MD Crittenton Hospital 1135 W University Dr, #420 Rochester, MI 48307 (248)650-4699 Katsuto Shinohara MD 1600 Divisadero Street, 3rd floor UCSF San Francisco, CA 94115 Tel:415-476-1611 Fax:415-476-8849 kshinohara@urol.ucsf.edu Assistant, Mary, at 415 353 9877 Prostate cancer pathology grading of biopsy fragments is notoriously difficult. Upon diagnosis it is recommended that men send their samples to a PCa pathology expert for rereading (experts can be found at http://www.prostate-help.org/cagleex.htm ) You might want to consider sending your recent samples off for expert reading. Having your free PSA measured (a simple blood test just like PSA) can also provide evidence for or against the presence of PCa...Best wishes and good health, Ron Thank you all very much for the informative responses. I'm new at this, so please forgive my inadvertently omitting some relevant facts when describing the situation. When my Urologist told me of the findings yesterday, he did mention that the prostate had chronic and acute inflammation (prostititis). The last 2 PSA tests (2.59 & 3.58) were only 6 months apart and, I can't recall with certainty, but ejaculation could be a factor the night prior to the PSA sample taken. After doing some research on the Net last night and reading a bit of Patrick Walsh's book, I called my Uro's office this am to ask some more specific questions. I couldn't speak with the Uro, but his nurse told me the recent biopsy (20 Jan) had 16 samples taken and the atypia results came from the right side of the prostate. Since Dr. Walsh's book stated that prostate biopsies in general are very had to evaluate by pathologists, and that any atypia results should be re-examined by a pathologist that specializes in prostate cancer, I wanted to get my Uro's opinion on this. Since he was unavailable, the nurse told me that their pathologist was very thorough, and said that if there was any doubt at all about his evaluation, then their pathology lab would send the samples out for another opinion and they didn't feel that was necessary. With that said, I'm wondering whether I should go ahead with the second biopsy evaluation, and with the omitted info provided, if anyone has any additional thoughts or comments on my situation. As before, I can't tell emphasize enough how much any comments or suggestions are appreciated. |
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