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What Are The Findings From The Biopsy Report?

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Posted on Mon, 17 Feb 2014
Question: Dr. XXXXXXX C. See, Good morning! How are you? I hope you are doing well! I am not sure if your remember me, but you have been quite helpful in answering my questions pertaining to my 74 year old father's rapid rise in PSA. Unfortunately, my dad had a biopsy report with cancer findings. He had 18 cores, and 9 came back with cancer. Could you please review findings, and answer my accompanying questions? Thanks! Final Diagnosis: 1.) Prostate-left apex-biopsy -Prostate tissue with a small focus of atypical glands. 2.) Prostate-left mid-biopsy -benign prostate tissue 3.) Prostate, left base, biopsy -Adenocarcinoma of the prostate. XXXXXXX score 4 +3= 7 involving 20% (1.5 mm in length) 1 of 2 core(s) 4.) Prostate, right apex, biopsy. -Adenocarcinoma of the prostate. XXXXXXX score 4 +5=9 involving 95%, 95%, and 60%). (5.5 mm, .5mm, and 4 mm in length) of 3 of 3 core(s). -Perineural invasion is identified. 5.) Prostate, right, mid, biopsy -Adenocarcinoma of the prostate. XXXXXXX score of 4+5=9 involving 95% (7 mm in length) of 1 of 2 core(s) -Adenocarcinoma of the prostate. XXXXXXX score of 4 +3=7 involving 80% (8.5 mm in length) of 1 of 2 core(s) - A total of 2 of 2 cores involved in carcinoma. 6.) Prostate, right base, biopsy -Adenocarcinoma of the prostate. XXXXXXX score of 4 +4=8 involving 85 and 70% (10 mm and 7 mm in length) of 2 of 3 core(s). 1.)Do you think, with this aggressive spiking, that my dad could have had this cancer spread to the spine, bones, and/or lymph nodes? 2.) If spread, what is the probability, and also how is it treated (i.e. hormonal therapy)? 3.) Have aggressive, or various other levels of prostate cancer not been effectively treated with radiation and chemotherapy? 4.) Is it possible to treat a spread to bone and/or lymph node with hormonal therapy? Would this hormonal therapy decrease the tumor cells? 5.) Can cancer staging, and also the possibility of cancer spread be determined by biopsy? 6.) Can regional or distal spread take place within a short time frame? 7.) I am concerned about time of being of the essence here. Should I worry about a week or two making a difference? 8.) Would you recommend a complete removal of the prostate gland in aggressive cancers, or is radiation and hormonal treatment enough and equal to prostate removal? I have been reading that by removing the prostate gland, one can more readily and fully detect the full pathology of the prostate. 9.) What is the survival rate? 10.) How long should I wait before starting these radiation treatments? 11.) How does hormonal treatment work on possible spread to bone and lymph nodes? Does it completely eradicate, or rather just slow down the cancer? 12.) Have you ever seen such high XXXXXXX numbers, with such high PSA spikes, and if so, what has been your understanding of how this treatment will work with such a challenging combination/aggressiveness? 13.) When you say the two tumors were found on the sides of the prostate, does this mean it has a poorer prognosis, and more of a chance of spreading? 14.)If half of the biopsies were negative, is this a good sign? 15.) 1.)Do you think, with this aggressive spiking, that my dad could have had this cancer spread to the spine, bones, and/or lymph nodes? 2.) If spread, what is the probability, and also how is it treated (i.e. hormonal therapy)? 3.) Have aggressive, or various other levels of prostate cancer not been effectively treated with radiation and chemotherapy? 4.) Is it possible to treat a spread to bone and/or lymph node with hormonal therapy? Would this hormonal therapy decrease the tumor cells? 5.) Can cancer staging, and also the possibility of cancer spread be determined by biopsy? 6.) Can regional or distal spread take place within a short time frame? 7.) I am concerned about time of being of the essence here. Should I worry about a week or two making a difference? 8.) Would you recommend a complete removal of the prostate gland in aggressive cancers, or is radiation and hormonal treatment enough and equal to prostate removal? I have been reading that by removing the prostate gland, one can more readily and fully detect the full pathology of the prostate. 9.) What is the survival rate? 10.) How long should I wait before starting these radiation treatments? 11.) How does hormonal treatment work on possible spread to bone and lymph nodes? Does it completely eradicate, or rather just slow down the cancer? 12.) Have you ever seen such high XXXXXXX numbers, with such high PSA spikes, and if so, what has been your understanding of how this treatment will work with such a challenging combination/aggressiveness? 13.) When you say the two tumors were found on the sides of the prostate, does this mean it has a poorer prognosis, and more of a chance of spreading? 14.)If half of the biopsies were negative, is this a good sign? 15.) Was this cancer caught early enough to obtain a successful eradication of this cancer? 16.) Can the disease become independent from hormone manipulation? 17.) What is meant by perineural invasion?
doctor
Answered by Dr. Manuel C See IV (15 days later)
Brief Answer: I am sorry about the biopsy result. Detailed Answer: Good Day and Thank you for your question, I am sorry to hear that your father's biopsy came out positive for prostate cancer. I will do my best to answer your question to the best of my knowledge and abilities: 1) Do you think, with this aggressive spiking, that my dad could have had this cancer spread to the spine, bones, and/or lymph nodes? The higher the PSA value the higher is the chance of having a stage IV disease or the prostate cancer has spread to the bone or lymph nodes. We are usually using a tool to give us percentages of the probability of lymph node involvement, and extra prostatic disease. This tool was developed by Johns XXXXXXX Prostate Cancer Center. For Your Father PSA more than 10, Gleasons 9 and Prostate Cancer present in both lobes the result showed that 6 % was organ confined meaning the cancer has not spread elsewhere, 27% had cancer outside the prostate involving the surrounding structures like the seminal vesicles etc. and 36% had lymph node involvement already. It is also important to have a total body bone scan done to check for bone cancer involvement. 2.) If spread, what is the probability, and also how is it treated (i.e. hormonal therapy)? If it has been proven your father has bone metastasis , treatment would be hormonal therapy. This would decrease the testosterone thereby controlling the cancer and limiting its growth. There were also cases where the bone metastsis decreased in size or disappeared with hormonal therapy. 3.) Have aggressive, or various other levels of prostate cancer not been effectively treated with radiation and chemotherapy? Tumor biology and behavior varies from patient to patient and what works in one patient may not work with same patient with same stage. Whats good about prostate cancer is there are treatment recommendation for every stage guided by well controlled studies by the best centers. 4.) Is it possible to treat a spread to bone and/or lymph node with hormonal therapy? Would this hormonal therapy decrease the tumor cells? Yes with hormonal treatment there is good cancer control and may decrease tumors in the bone and limit growth of lymph nodes. 5.) Can cancer staging, and also the possibility of cancer spread be determined by biopsy? Yes the XXXXXXX score in the biopsy allows us to compute for the aggressiveness and the risks for spread as i have answered in number 1 question. 6.) Can regional or distal spread take place within a short time frame? 7.) I am concerned about time of being of the essence here. Should I worry about a week or two making a difference? For a XXXXXXX 9 prostate cancer it is one of the more aggressive type of prostate cancer. I believe you can wait for a week or two without any clinical consequence but do not delay for more than two months. 8.) Would you recommend a complete removal of the prostate gland in aggressive cancers, or is radiation and hormonal treatment enough and equal to prostate removal? I have been reading that by removing the prostate gland, one can more readily and fully detect the full pathology of the prostate. I don't think prostate surgery would be beneficial for your father since the chances of prostate confined cancer is only 6%. It might put your father to undue stress of surgery without a real benefit clinically. 9.) What is the survival rate? the survival rate for a high risk prostate cancer (Gleason 9, both lobes involved) would be 50% in 5 years after radiation therapy. 10.) How long should I wait before starting these radiation treatments? An acceptable waiting time would be 2 weeks prior to start of radiation therapy. That will be ample time to seek consult with a radiation oncologist. 11.) How does hormonal treatment work on possible spread to bone and lymph nodes? Does it completely eradicate, or rather just slow down the cancer? Hormone therapy slows down the growth of prostate cancer and in some cases there was decrease in the numbers of bone cancer cells and significant decrease in cancer progression. 12.) Have you ever seen such high XXXXXXX numbers, with such high PSA spikes, and if so, what has been your understanding of how this treatment will work with such a challenging combination/aggressiveness? If i were your treating Urologist and bone scan would come out negative then i would recommend radiation therapy w or w/o hormonal therapy. If the bone scan would come out positive then i would start your father with hormonal therapy. 13.) When you say the two tumors were found on the sides of the prostate, does this mean it has a poorer prognosis, and more of a chance of spreading? Bilateral prostatic involvement would mean catching the disease late and it has progressed to spread to the other lobe already. XXXXXXX Score would be more attributed to aggressiveness. In terms of prognosis and survival a bilateral prostatic lobe involvement would have a slight worse prognosis than a prostate cancer with one lobe involvement only. 14.)If half of the biopsies were negative, is this a good sign? Yes it is better to have half of the prostate still with normal tissue and carries a better prognosis than a prostate with 95% cancer involvement. 15.) Was this cancer caught early enough to obtain a successful eradication of this cancer? I think it may have been a little late since there is already bilateral lobe involvement. 16.) Can the disease become independent from hormone manipulation? Yes after months to years of hormonal manipulation it may become hormone refractory (how long also varies from patient to patient) and the hormones may no longer work for the prostate cancer. After that we usually give chemotherapy and orher 2nd and 3rd line agents to control the cancer. 17.) What is meant by perineural invasion Perineural invasion on a prostate biopsy result carries a negative / or a bad prognosis as compared with no perineural invasion. It means the cancer cells may have spread outside the prostate gland. I Hope i was able to answer your question and I have given light to some of your doubts and concerns. Sincerely yours, Manuel See IV, MD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manuel C See IV (14 hours later)
Thank you so very much! My dad does have bone metastastis, and it is all over his skeletal system, but no lymph involvment. Do you think radiation is also possible, even though it spread? Dad is presently on Lupron. Sincerely, XXXXXXX
doctor
Answered by Dr. Manuel C See IV (18 minutes later)
Brief Answer: No radiation has no more role in stage iv disease Detailed Answer: Good Day and thank you for being with Healthcare Magic! For stage iv prostate cancer disease there is no more role for radiation only hormonal therapy since the disease is already systemic. Uses for radiation would be for treatment of severe bone pain due to cancer, or on clinical trials. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: WWW.WWWW.WW I would gladly help you. Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manuel C See IV (8 hours later)
Hi! The MD's, Urologists, feel that it can help control the aggressive tumors from re-firing down the road. Could it be a bad thing to give it a try? I heard radiation could cause bladder cancer. XXXXXXX
doctor
Answered by Dr. Manuel C See IV (3 hours later)
Brief Answer: May or may not work. Detailed Answer: dear XXXXXXX Radiation therapy for stage iv prostate cancer is purely In the context of clinical trial. If your Urologist feels it may help down the road for better cancer control then you may try it but ask about how much will it improve survival? Studies are not very clear on this topic and the latest consensus issued by the NCCN said radiation has no role on stage iv prostate cancer since benefit is not yet proven. That being said you may ask doctor about side effects of radiation therapy. Common side effects would be voiding and bowel problems because the bladder and the rectum might be affected by the radiation. This can happen and manifest after 1-2 years or more after radiation. Secondary malignancies like you mentioned may also occur like bladder and colon cancer but not as common as the voiding and defacation problems which could run as high as 20% incidence rate after radiation. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: WWW.WWWW.WW I would gladly help you. Best wishes.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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What Are The Findings From The Biopsy Report?

Brief Answer: I am sorry about the biopsy result. Detailed Answer: Good Day and Thank you for your question, I am sorry to hear that your father's biopsy came out positive for prostate cancer. I will do my best to answer your question to the best of my knowledge and abilities: 1) Do you think, with this aggressive spiking, that my dad could have had this cancer spread to the spine, bones, and/or lymph nodes? The higher the PSA value the higher is the chance of having a stage IV disease or the prostate cancer has spread to the bone or lymph nodes. We are usually using a tool to give us percentages of the probability of lymph node involvement, and extra prostatic disease. This tool was developed by Johns XXXXXXX Prostate Cancer Center. For Your Father PSA more than 10, Gleasons 9 and Prostate Cancer present in both lobes the result showed that 6 % was organ confined meaning the cancer has not spread elsewhere, 27% had cancer outside the prostate involving the surrounding structures like the seminal vesicles etc. and 36% had lymph node involvement already. It is also important to have a total body bone scan done to check for bone cancer involvement. 2.) If spread, what is the probability, and also how is it treated (i.e. hormonal therapy)? If it has been proven your father has bone metastasis , treatment would be hormonal therapy. This would decrease the testosterone thereby controlling the cancer and limiting its growth. There were also cases where the bone metastsis decreased in size or disappeared with hormonal therapy. 3.) Have aggressive, or various other levels of prostate cancer not been effectively treated with radiation and chemotherapy? Tumor biology and behavior varies from patient to patient and what works in one patient may not work with same patient with same stage. Whats good about prostate cancer is there are treatment recommendation for every stage guided by well controlled studies by the best centers. 4.) Is it possible to treat a spread to bone and/or lymph node with hormonal therapy? Would this hormonal therapy decrease the tumor cells? Yes with hormonal treatment there is good cancer control and may decrease tumors in the bone and limit growth of lymph nodes. 5.) Can cancer staging, and also the possibility of cancer spread be determined by biopsy? Yes the XXXXXXX score in the biopsy allows us to compute for the aggressiveness and the risks for spread as i have answered in number 1 question. 6.) Can regional or distal spread take place within a short time frame? 7.) I am concerned about time of being of the essence here. Should I worry about a week or two making a difference? For a XXXXXXX 9 prostate cancer it is one of the more aggressive type of prostate cancer. I believe you can wait for a week or two without any clinical consequence but do not delay for more than two months. 8.) Would you recommend a complete removal of the prostate gland in aggressive cancers, or is radiation and hormonal treatment enough and equal to prostate removal? I have been reading that by removing the prostate gland, one can more readily and fully detect the full pathology of the prostate. I don't think prostate surgery would be beneficial for your father since the chances of prostate confined cancer is only 6%. It might put your father to undue stress of surgery without a real benefit clinically. 9.) What is the survival rate? the survival rate for a high risk prostate cancer (Gleason 9, both lobes involved) would be 50% in 5 years after radiation therapy. 10.) How long should I wait before starting these radiation treatments? An acceptable waiting time would be 2 weeks prior to start of radiation therapy. That will be ample time to seek consult with a radiation oncologist. 11.) How does hormonal treatment work on possible spread to bone and lymph nodes? Does it completely eradicate, or rather just slow down the cancer? Hormone therapy slows down the growth of prostate cancer and in some cases there was decrease in the numbers of bone cancer cells and significant decrease in cancer progression. 12.) Have you ever seen such high XXXXXXX numbers, with such high PSA spikes, and if so, what has been your understanding of how this treatment will work with such a challenging combination/aggressiveness? If i were your treating Urologist and bone scan would come out negative then i would recommend radiation therapy w or w/o hormonal therapy. If the bone scan would come out positive then i would start your father with hormonal therapy. 13.) When you say the two tumors were found on the sides of the prostate, does this mean it has a poorer prognosis, and more of a chance of spreading? Bilateral prostatic involvement would mean catching the disease late and it has progressed to spread to the other lobe already. XXXXXXX Score would be more attributed to aggressiveness. In terms of prognosis and survival a bilateral prostatic lobe involvement would have a slight worse prognosis than a prostate cancer with one lobe involvement only. 14.)If half of the biopsies were negative, is this a good sign? Yes it is better to have half of the prostate still with normal tissue and carries a better prognosis than a prostate with 95% cancer involvement. 15.) Was this cancer caught early enough to obtain a successful eradication of this cancer? I think it may have been a little late since there is already bilateral lobe involvement. 16.) Can the disease become independent from hormone manipulation? Yes after months to years of hormonal manipulation it may become hormone refractory (how long also varies from patient to patient) and the hormones may no longer work for the prostate cancer. After that we usually give chemotherapy and orher 2nd and 3rd line agents to control the cancer. 17.) What is meant by perineural invasion Perineural invasion on a prostate biopsy result carries a negative / or a bad prognosis as compared with no perineural invasion. It means the cancer cells may have spread outside the prostate gland. I Hope i was able to answer your question and I have given light to some of your doubts and concerns. Sincerely yours, Manuel See IV, MD.