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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2005High Grade PIN
Hi all, I have read through most of the your posts and realize that PCa is a whole new world to me. I wish all of you the best. I may be premature posting here so forgive me if I am. I am a 50 year old and do to a series of events ended up having a prostate biopsy the end of November. My PSA is 2.2. Four years ago my PSA was 2. When I made my appointment with my Urologist my PSA was 3, but I had the PSA retested and it was 2.2. On the DRE one side of my prostate did not feel like the other. I work for a medical reference lab and the clinic here does my blood work. My Urologist emailed me a week after the biopsy and said that "most of my biopsies had PIN which is viewed as a risk factor for the presence of cancer". On the internet I read that when a Urologist talks of PIN and another biopsy that the PIN is high grade. One of the Cytology Pathologist here at work had my slides and pathology report sent over and all but one of the slides had high grade PIN. I was able to view my slides with a teacher student learning microscope and see my PIN. That was an experience! My next biopsy is in 2 weeks. From other things I read on the internet, if my prostate were out the pathologist would find cancer based on some autopsy case studies. My guess, from what I have read, is that I have a 50% chance that the next biopsy will find PCa. If I join the club, then I have found a great resource for what will come next. If I do not join the club, then I guess more PSA's, DRE's, and Biopsy needles. Has anyone else found themselves in a similar situation and is my thinking correct? Thank you, Mark Your thinking is correct in the fact that you are being tested and are following up. A PSA rise from 2.2 to a 3 can be caused by many factors other than PCa. I believe, and I could be somewhat off here on the exact age, a PSA over 2.5 in a 50 year old man can be a cause for some concern. The high PIN on the first biopsy and the abnormal DRE is a more definitive cause for concern. (and another biopsy). The second biopsy should prove informative. You are doing the right thing to make sure. B.A. > Hi all, > I have read through most of the your posts and realize that PCa is a whole [quoted text clipped - 21 lines] > Thank you, > Mark In ambiguous cases, a free PSA test can sometimes be helpful. Thanks Leonard. I did do a free PSA on the last PSA test. The free PSA was 18%. I know that free PSA works better for PSA's over 4 so I am not sure how well the 18% fits into the free PSA ranges. I know that less than 7% would be a good indicator for PCa and above 25% would be an indicator of BPD so 18% should mean no PCa for me at this time. I do appreciate you and Bob responding to my post. One of the medical directors on staff here was on the internation committee on PSA 15 years ago. He is a full supporter of the free PSA test. He believes that the free PSA should be the test of choice and not the PSA. He also said that my 18% was more like a guess because the PSA was 2.2 and the instrument could not give a good free PSA reading with such a low PSA. The medical director was surprised that my urologist wanted to still do a biopsy in the first place but with the DRE I understood why. Even with the PIN result the medical director stills says that I will not have PCa on my next biopsy which may be the case. I even spoke with the pathologist that did the pathology on my first biopsy today. He said he has seen people with high grade PIN not have PCa after 17 years of biopsies. He did read to me a study done a month and a half ago that says I have about a 1 in 4 chance of having Pca. Like Bob says the best I can do for myself is to continue to follow-up. I know this is a public group so I hope what I write may help others as well. Thank you both for your replies. Mark >> Hi all, >> I have read through most of the your posts and realize that PCa is a [quoted text clipped - 24 lines] > > In ambiguous cases, a free PSA test can sometimes be helpful. Mark, I'm interested in PIN because I had it when I got biopsied at age 50. I found out I had a gleason 3+3=6 on repeat. the following article may interest you. Journal of Urology Volume 175, Issue 1, Pages 121-124 (January 2006) Risk of Prostate Cancer on First Re-Biopsy Within 1 Year Following a Diagnosis of High Grade Prostatic Intraepithelial Neoplasia is Related to the Number of Cores Sampled Mehsati Herawia, Hillel Kahaned, Christina Cavallod, Jonathan I. Epstein We determined the influence of the extent of needle biopsy sampling on the detection rate of cancer on first biopsy within 1 year following a diagnosis of HGPIN. Materials and Methods We identified 791 patients with HGPIN on the initial biopsy who had a followup biopsy within 1 year of their diagnosis. The mean interval from diagnosis of HGPIN to re-biopsy was 4.6 months. In the initial biopsy with HGPIN, 323 men had 8 or more cores (median 10, range 8 to 26) and 332 men had 6 core biopsies. Results In the 6 core initial sampling group, the risk of cancer on re-biopsy was 20.8% compared to only 13.3% following an initial 8 core or more sampling (p = 0.011). With 6 core biopsies for both the initial and re-biopsy the risk of cancer was 14.1% (group 1). With an initial 6 core biopsy and 8 core or more biopsy on followup, the risk of cancer was 31.9% (group 2). With 8 core or more biopsy sampling for both initial and repeat biopsies, the risk for cancer was 14.6% (group 3). The differences between groups 1 and 3 as compared to group 2 were statistically significant (p = 0.001 and p <0.0001, respectively). Conclusions With relatively poor sampling (6 cores) on the initial biopsy, associated cancers are missed resulting in only HGPIN on the initial biopsy, and with relatively poor sampling on re-biopsy there is also a relatively low risk of finding cancer on re-biopsy (group 1). With poor sampling on the initial biopsy and better sampling on re-biopsy, some of these initially missed cancers are detected on re-biopsy yielding a higher detection of cancer (group 2). Sampling more extensively on the initial biopsy detects many associated cancers, such that when only HGPIN is found they often represent isolated HGPIN. Therefore, re-biopsy even with good sampling does not detect many additional cancers (group 3). Our study demonstrates that the risk of cancer on biopsy within 1 year following a diagnosis of HGPIN (13.3%) is not that predictive of cancer on re-biopsy if good sampling (8 or more cores) is initially performed. For patients diagnosed with HGPIN on extended initial core sampling, a repeat biopsy within the first year is unnecessary in the absence of other clinical indicators of cancer. Steve U Steve, Thank you. A very interesting article. On your first biopsy, did the Urologist do a small core sample of 6 or a larger sample? For me I think he did at least 8. For every needle that went in below the dentate line, the pain made me forget how many needle biopsies had taken place. Did you have any other indicators of PCa? I hope you are doing well now. I have one Uncle who had PCa at 65, another Uncle with BPD at 67, and a Father who at 75 did not want to do a follow-up biopsy because of the after effects of surgery on his 2 brothers. All three had biopsies the same year. So from a genetic standpoint, I figure I am at a higher risk. Thank you, Mark > Mark, > I'm interested in PIN because I had it when I got biopsied at age 50. I [quoted text clipped - 47 lines] > > Steve U Supposedly, fathers who have PCa, unless that PCa occurs in their 30s or 40s, do not increase the chances of sons getting PCa. Similarly, there is supposedly no connection (other than locality) between PCa and BPD. That said, your genes would seem to be weak in the area.  SignaturePSA 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 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum > Steve, > Thank you. A very interesting article. On your first biopsy, did the [quoted text clipped - 59 lines] >> >> Steve U Mark, Back in 7/2003 my urology group's standard was 6 biopsies. At the repeat I wanted 12. They agreed, and internally they had been on the edge of increasing the number done routinely anyway. None of them hurt much. I had no symptoms, and had a negative DRE. There was no family history of PCA. PSA at my 50 yr check up was 4.5, and it went up to 5.6 five months later. The free PSA was low at 15%. I had a Robotic Laparoscopic RP in February of 2004. I am very happy with my results. I was able to go home 20 hours later, and back to work day 6. All PSAs have been <0.1. Now I never leak, and a most of my erection ability has returned. Steve U Thank you Steve for this information. It shows to me that PCa is not bound by many rules. I am happy that things have worked out well for you. Mark > Mark, > Back in 7/2003 my urology group's standard was 6 biopsies. At the [quoted text clipped - 8 lines] > returned. > Steve U
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