Isn't a biopsy supposed to confirm or deny suspicion?

[MissMillie]

My guy had a biospy on a "spot" found on an MRI of his prostate. The doctor called him with the "results" this past week, and they had left me quite confused.

I wasn't on the call. If I had been, I would not have let the doctor get away with telling my guy that they're going to keep an eye on this "suspicious" spot--with a follow up appointment (and possible 2nd MRI) in six months.

???????

Does that mean...

...it's cancerous, but it's in a location where removing it could be more dangerous than keeping an eye on it? (If it's cancer, I can't imagine why there would be a delay removing it unless this is the case) or

...it's "pre-cancerous"?

Somehow it seems to me the point of having a biopsy is to remove the suspicion. My guy got off the phone thinking he has cancer, despite the fact that the doctor never used that term.

I imagine that hearing that the doctor needs to continue to monitor the situation may have spooked my guy (I mean, he thinks he has cancer!) but I'm a little miffed that my guy didn't ask these follow-up questions. Even if my guy assumed that the doctor was telling him he had cancer, why didn't he ask about a 6 month delay in action?

If someone told me I had cancer and that nothing was going to happen for another 6 months, I'd pitch a fit!

[hlthe2b]

1. "Equivocal"-- sorry but that is not uncommon. It means the lab could not be confirm

usually because of a poor sample especially from fine needle aspirate cytology as opposed to full tissue biopsy), but it can also mean they saw no cancerous changes, but that with the particular cancer being ruled out (e.g., very slow-growing types) or tissue being looked at it is worthy of close watch. That can be common very early and if clinical signs warrant, they would relay to the submitting physician that they should consider it necessary to reassess frequently.

If it helps, pathologists usually request additional samples if they feel that would help clarify. If they did not, then it just warrants some further follow-up in the future and I would still take this as reassurring.

I know it is frustrating, but quite common. Best wishes to you both.

[JohnSJ]

2. Depends on the grade. If it is a low grade, it is not unreasonable to do what is called Active

Surveillance for a prostate cancer

The fact that his physician is recommending that indicates that he is well versed on dealing with prostate cancer

If he wants to get a second opinion on the reading of the slides from the biopsy, there are centers that will do that.

There is a lot of information out there on prostate cancer, and treatment options, including Active Surveillance.

[viva la]

3. My last colonoscopy had results like that--

"Must monitor it-- come back in 5 years." That is, no big deal. still scary!

"Precancerous" is most likely. Also, with prostate in older men, the growth of any tumor is often so slow, there's little danger- they die of other old-age problems first..

But you two need to have a conference with the doctor. Your guy needs the straight info, which will probably calm his nerves a lot. You might also get a referral for a urologist, who can do more chronic care.

[MissMillie]

18. It was a urologist that did the biopsy (n/t)

.

[viva la]

21. He would have referred him to an oncologist

if there was cancer, surely.

I think you and he need to call the doctor, and you'll get the real story. Guy probably was too anxious to really understand what the dr was saying.

[lark]

4. Bet a lot the dr. said pre-cancerous and all he heard was cancer, that happened to a friend.

I had a similar situation. Dr. said I had pre-cancerous cysts when I was in my mid 30's. 10 years later I had breast cancer on 1 side with prediction of breast cancer on other side within a few years and got both removed. No more mammograms every 6 months and the stomach churn of total anxiety for each visit. I dealt with the worst and moved on. That was over 20 years ago and nothing escaped to metatasize - so thankful!

[dweller]

5. The 'watch and wait' is worthless imo

Did your guy have his blood drawn for a PSA count ?
Does he know what his PSA is?
PSA is a measure of ‘prostate specific antigen’ in the blood,
normal is 0-4, depending on his age could be slightly higher.
His Gleason score would be the results of the biopsy with higher scores indicative of cancer.
It would be helpful for you to have these #’s


✌🏻

[JohnSJ]

10. Active Surveillance is NOT worthless. If the gleason grade is a 3+3 and small volume, the next step

would be to do one of the genetic tests to determine how much risk there is.

As for PSA, it is just a data point, and not necessarily diagnostic, since there are many reasons for an elevated PSA, including benign things such as riding a bicycle, having sex within 48 hours of having a blood draw, to an enlarged prostate, or prostatitis, etc.

The biopsy is the only way to determine what one is dealing with, and if it is low grade, it is very prudent to do Active Surveillance.

Active Surveillance is NOT "watch and wait". You monitor it.

Prostate surgery or radiation is a major deal, and the side effects can be very significant.

The whole school of thought in dealing with prostate cancer has changed significantly from 20 years ago. Every major comprehensive cancer center in the country will suggest Active Surveillance if the grade and volume merits it.

[dweller]

16. I specifically opened my post with 'imo'

as in ‘in my opinion’ … to the OP
You sound like a medical professional, and I am not.
I am instead an active patient immersed in cutting edge treatment for prostate cancer.
After too many years of nothing more than DREs and comments like ‘ your prostate is enlarged, we’ll have to wait and watch that’ I can understand the OP’s frustration in not knowing information that could be helpful.
I am fully aware of the advances in treatment for PC since I’ve been fully immersed in it for the last 3 years … also aware of the increase in occurrence of PC , as it is now #1 cancer in men, according to Cancer.org
As I posted to the OP knowing some specific test #’s, both PSA and Gleason scores would be helpful knowledge. Any dr unable to provide that info, well I’d be looking for a 2nd opinion at least.
And again, this is just my opinion… don’t even get me started on the sorry state of health care in this country … too many people including myself fall between the cracks, with many disastrous outcomes.

YMMV

✌🏻

[JohnSJ]

17. Of course. This is a forum for opinions, and if my response sounded abraisve that sure wasn't my

intention, and I apologize for that impression.

All I was trying to point out was that "active surveillance" is not the same thing as "wait and watch"

Second opinions are always good.

One of the most important things one can do is to educate themselves as much as possible, and take a pro-active approach, because as you said, "too many people fall between the cracks"

Take care

[MissMillie]

19. His PSA was elevated

which is why there was an MRI... which is why there was a biopsy

[JohnSJ]

12. You are absolutely right Chin. In addition, a diagnosis of prostate cancer does not mean a death

sentence.

[PortTack]

7. There can be what's called atypical cells which means they are not quite normal, but not as yet

A cancerous tumor. Atypical cells can stay the same for years and never become cancerous. His doctor is correct if this is the case. He just needs to follow up as often as suggested.

Nurse here

[MissMillie]

20. that sounds familiar

my pap smears, for a while, came back like that.

That's helpful, thank you.

[woodsprite]

8. When I first had a biopsy for what eventually turned out to be cancer,

The number/make up of the cells they found put me in a "suspicious" category. My GYN kept watch on me every 3 months to see if there were any changes, put me on some meds. About 2 years and procedures after that, I ended up having an ablation to take care of some bleeding issues. Eighteen months after the ablation, I had another biopsy because I was having problems again. That biopsy came back as endometrial adenocarcinoma Grade 1 and prompted my surgery (total hysterectomy). So it was about 5 yrs from my initial "suspicious" biopsy result to being diagnosed with early grade/stage cancer. There had always been a chance that the hormones he put me on would have resolved the issue, but that wasn't the case. I know several friends who have had suspicious cervical biopsies that resolved over a year or two and had only been monitored.

There may be suspicious cells, but as my Dr. told me, any biopsy is only as good as the speck of tissue removed. Apparently years ago, the volume of bad to good cells was very very low and only 1 sampling was done. Did they sample multiple spots with your husband's biopsy? That would be a good question to ask. My last biopsy in February (15 yrs after the original diagnosis/surgery), the interventive radiologist sampled 5 different places in and around the mass. I am currently finishing up a years worth of treatment - 4 rnds chemo, surgery, 2 rnds chemo, 25 rnds external rads (I'm almost halfway through this phase), then 3 rnds internal rads.

It's a shock to hear, or even think, that "C" word. It throws you for a loop. My oncologist and GYN both encouraged me to do my own research once I was diagnosed and discuss options with them.

I hope that the suspicious cells clear up for your husband. Sending positive thoughts to both of you!

[mitch96]

9. I believe the biopsy failed to show what the mri showed. It might look like CA on the scan

but the bx was negative hence the watch and wait. Then again they could have missed the spot when they did the biopsy and got clean tissue... More tests... CT scan, Nuclear medicine scan Ultrasound? maybe another Bx in a few months? If it is CA then they would catch it early which is always a plus. ymmv

m

[JohnSJ]

15. Very true, and hopefully they did what is referred to as a directed biopsy based on the

results

A lot of the directed diagnostics use what is referred to as a Fusion guided prostate biopsy, which combines magnetic resonance imaging (MRI) with ultrasound, for a targeted biopsy of the prostate of the suspicious area.

[mitch96]

22. It's been a while since I was in the medical field.. Fusion bx was just coming in when I

was leaving... Sounds like an Inside and outside look.. I wonder what kind of non magnetic/non ferrous probe they would use. Don't want any metal in the MRI don't cha know.
m

[58Sunliner]

11. Get a copy of the medical records including test and biopsy results.

Only way to know what exactly he is looking at. And if the tests are inconclusive, go back to have another chat with the dr as to why and what else can be done. I assume your friend is having some symptoms. And get a second opinion if need be. No one should be left in the dark because the dr may have not explained the results or diagnosis well enough in plain and simple english.

[JohnSJ]

13. I strongly recommend the book "Invasion of the Prostate Snatchers", by Dr. Mark Scholz, to educate

yourself what you are dealing with. There is a lot of information out there, and educating oneself is important.

https://www.amazon.com/Invasion-Prostate-Snatchers-Essential-Managing/dp/1635421861/ref=sr_1_1?gclid=CjwKCAiA24SPBhB0EiwAjBgkhpEY3ImGklGkk52UrtKuKaNkwJ5IxV_NjC5wDXfdUbgc7iAvPxJESRoCUIMQAvD_BwE&hvadid=241602298501&hvdev=c&hvlocphy=9060440&hvnetw=g&hvqmt=e&hvrand=1382356774421494700&hvtargid=kwd-21233657107&hydadcr=15555_10342232&keywords=invasion+of+the+prostate+snatchers&qid=1642175961&s=books&sr=1-1