Validity of a prostate biopsy

On January 29, Armand inquired:

> A relative of mine had recently a prostate biopsy. The report
> recommended "...to renew in 3 months from now the dosage of total PSA
[quoted text clipped - 3 lines]
> Could you, please, explain what this could mean?
>

If accurately quoted, I think it's rather oddly stated. It could just be
another medic who is unable to express himself clearly, though.

What is meant by "dosage" is uncertain. I think that the writer meant
"level" of the two forms of PSA in the blood.

The balance of the statement is, in my amateur opinion, well-said. Since
the biopsy specimens are of only a very small part of the gland, it is
possible to miss a cancerous lesion. This has happened to me. The lesion
was discovered via a followup biopsy.

Regards,

Steve J

"The thing is to expect nothing in particular, but be aware of the lack
of enforceable guarantees or enforceable contracts with
nature/god/entropy as to the condition or durability of our bodies."
-- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate
Problems Mailing List
Thank you, Brian.

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>Hi,
>
[quoted text clipped - 4 lines]
>outside affected zones...".
>Could you, please, explain what this could mean?

That's why I'm advocating Power Colour Doppler Imaging in lieu of the
poorly defined GreyScale Imaging now used in TRUS Biopsies.

In truth, your Tumour could be scattered all through your Prostate
like pieces of Fat in Salami. The Power Colour Doppler method paints a
better picture for the Operator to harvest the Cores.

I had 10 cores sampled the old way and only 9 were reported on, (1
misfire), and of those, 6 were significantly malignant. (I guess I had
a good Operator.)

-- Reader to complete...
-- Please reply to this ng as my email adress is fake:

-- Regards

-- CC

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> Hi,
>
[quoted text clipped - 7 lines]
> Thanks & cheers,
> Armand

I think it is fairly clear English is not your native language. My
interpretation of what you said follows below, but it is not possible to
be sure of your meaning because of the language difficulty.

I think most likely your relative's biopsy was negative, but the doctor
recommended a second biopsy in three months. His reasons for doing so
apparently were that the total PSA level was high enough to be of
concern and that the free PSA percentage was low enough also to be of
concern. High PSA can be caused by things other than prostate cancer.
Indeed, it usually is. But they can measure something called free PSA
also, and if the ratio of that to the total is below a certain level,
that makes prostate cancer more likely, though by no means cerrtain.
Since the biopsy procedure just samples the prostate, it is possible for
the probes to miss a cancer that is there. This isn't too likely, but
in this case the other evidence makes it likely enough that another
biopsy is merited further down the line. By then, further PSA readings
may also help figure out just what is happening.

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In this case, positive means that they found cancer in the sample.

> accompanied with a dosage of free PSA since a biopsy has MEANINGFUL
> VALUE ONLY IF IT IS POSITIVE because it could have been performed

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<sez_ar@yahoo.com asked

> [my doctor says] a biopsy has MEANINGFUL
> VALUE ONLY IF IT IS POSITIVE because it could have been performed
> outside affected zones...".
> Could you, please, explain what this could mean?

A negative value (no cancer found) means the sampling needle hit no cancer.
It doesn't mean there IS no cancer, just that the needles didn't hit any.
Thus a negative sample means nothing (has no meaningful value). It does
imply your prostate isn't full of cancer, but that's no guarantee there is
none there, and it doesn't need to be full of cancer to be serious.

A positive sample, by definition, found cancer. That means you DO have
cancer. That's obviously meaningful, and the next questions are how much
cancer and how aggressive is it? The samples will help answer those
questions.

I.P.

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Hi,

A relative of mine had recently a prostate biopsy. The report
recommended "...to renew in 3 months from now the dosage of total PSA
accompanied with a dosage of free PSA since a biopsy has MEANINGFUL
VALUE ONLY IF IT IS POSITIVE because it could have been performed
outside affected zones...".
Could you, please, explain what this could mean?

Thanks & cheers,
Armand

Biopsy results can only mean that there is cancer or not in the
specific tissue that was extracted by needle. You are playing the odds
that the needle went in where the cancer cells were. I had 14 biopsies
and only one of the 14 core samples showed cancer cells and in that
sample the cancer cells were less than 5% of the sample. Yet, 10% of my
entire prostate was cancerous as determined by the post-surgical
pathology report. So your relative's doctor is saying if the PSA
remains high, we should do more tests. Elevated PSA could be the result
of other conditions besides cancer and if it goes down by the next
test, it might not be necessary to do another biopsy. But just because
there was no cancer in the samples of this biopsy doesn't mean there is
no cancer. Free PSA is a blood test that separates the reading of the
free PSA (which travels in the blood stream away from the prostate).
The higher the free PSA, the less likelihood of cancer. Lower PSA
readings means that the PSA is concentrated in the prostate and there
is greater chance of cancer. Detection of prostate cancer is all about
the odds.

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Hi,

A relative of mine had recently a prostate biopsy. The report
recommended "...to renew in 3 months from now the dosage of total PSA
accompanied with a dosage of free PSA since a biopsy has MEANINGFUL
VALUE ONLY IF IT IS POSITIVE because it could have been performed
outside affected zones...".
Could you, please, explain what this could mean?

Thanks & cheers,
Armand

Biopsy results can only mean that there is cancer or not in the
specific tissue that was extracted by needle. You are playing the odds
that the needle went in where the cancer cells were. I had 14 biopsies
and only one of the 14 core samples showed cancer cells and in that
sample the cancer cells were less than 5% of the sample. Yet, 10% of my
entire prostate was cancerous as determined by the post-surgical
pathology report. So your relative's doctor is saying if the PSA
remains high, we should do more tests. Elevated PSA could be the result
of other conditions besides cancer and if it goes down by the next
test, it might not be necessary to do another biopsy. But just because
there was no cancer in the samples of this biopsy doesn't mean there is
no cancer. Free PSA is a blood test that separates the reading of the
free PSA (which travels in the blood stream away from the prostate).
The higher the free PSA, the less likelihood of cancer. Lower PSA
readings means that the PSA is concentrated in the prostate and there
is greater chance of cancer. Detection of prostate cancer is all about
the odds.

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sez_ar@yahoo.com - 30 Jan 2006 21:47 GMT

Hi all,

Thanks for your valuable comments. One thing I understood and I agree
with is that the doctor's competence leaves some doubt in my mind. He
wrote about "...increasing total PSA..." but from your explanations and
from my readings on the internet, I understood that the PSA is
naturally in the prostate and it can't be about increasing it to test a
prostate cancer...
Thanks again for your help.
Cheers,
Armand

> Hi,
>
[quoted text clipped - 25 lines]
> is greater chance of cancer. Detection of prostate cancer is all about
> the odds.

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juniper - 31 Jan 2006 01:51 GMT

Armand,

This is getting more and more confusing. Is it too much to put the
entire report up here? It might be easier to see what he is saying if
we see it in context. Also the PSA test results.

> wrote about "...increasing total PSA..." but from your explanations and
> from my readings on the internet, I understood that the PSA is
> naturally in the prostate and it can't be about increasing it to test a
> prostate cancer...

To me, this meant that _if the total PSA keeps increasing_... (Not
increasing the PSA as if it was a dosage you give.) Yes, PSA is
naturally in the prostate. And it is supposed to stay there. When the
integrity--the structure--of the prostate is damaged, then PSA leaks
out into the blood. The blood test tells you how much has leaked from
the prostate.

Now, a lot of things can cause this damage, and most causes of leaking
PSA are temporary. So PSA might go up, but then it goes back down.
But if prostate cancer is causing the "leak" into the blood, then the
damage will only get worse. So the PSA will only get higher.

Other things cause increasing PSA levels, too. BPH, for one. So it is
not *necessarily* cancer. But an increasing PSA is a sign. Also, the
total PSA matters. Because most "nice" causes of high PSA will only
raise the PSA to a certain point. Under 10, probably. A PSA reading
over 10 or 15 is a pretty strong sign of cancer.

Anyway, this report is confusing enough, and I think if you could put
the whole thing here, we might be able to figure it out better. Also,
tell us if you translated it, because that will help. Even

Was the biopsy positive? I understood this to say the biopsy was
negative but it didn't count, because only a positive biopsy tells you
for sure. Then you look for rising PSA levels in the blood and other
signs. Does he have an enlarged prostate? How high is his PSA? If he
had more than one PSA test, what were all the numbers? And the dates?

regards,
laurel

> > Hi,
> >
[quoted text clipped - 25 lines]
> > is greater chance of cancer. Detection of prostate cancer is all about
> > the odds.

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