Results of Biopsy

Kongo said:

Your Father
Daughter,

I'm sorry your father received such information on the telephone when he was not prepared to receive the news. I recall when I received my face-to-face report and remember very little after the urologist said, "Unfortunately, your biopsy shows that you have prostate cancer..."

From the little information you are able to provide, it's impossible to speculate what "mixed cells" might mean in a way that can give you any useful information at this early stage. I'm sure the urologist is scheduling your father for a follow-up appointment in the very near future where he will go over the pathology of his biopsy report in detail and discuss treatment options.

The first session is much like trying to take a sip of water from a fire hose at full pressure. There is going to be a lot of information, much of it technical, that is going to be unfamiliar. Your father should consider taking someone with him to the appointment who can ask questions too and take notes. It would be a good idea to take along a tape recorder.

There are many questions you should be prepared to ask the urologist. The following are some that come quickly to mind and I'm sure others will chime in with suggestions too.

1. What is my Gleason score and what does that mean? Is there a tertiary Gleason score? From the location of the positive locations on the biopsy, ask the doctor to point out where these are on a plastic model of the prostate that he should have in the office.

2. What is the stage of my cancer?

3. Can you arrange to have a second opinion done for the biopsy slides at someplace like Johns Hopkins?

4. Would you rate my cancer as low, intermediate, or high risk?

5. What was the volume of my prostate? (They calculated this when they did the ultrasound biopsy). From this volume, can you please calculate the PSA density? What does that number mean? From my history of PSA scores, can you calculate my PSA doubling time and PSA velocity? Can you explain the significance of these numbers? Has my free PSA percent been calculated?

6. What treatment option does the doctor recommend? Why? What are the side effects of this treatment optionin terms of urinary continence, rectal toxicity, and sexual function? (The doctor should explain a range of options but at a minimum he should cover surgery, various forms of radiation, and (depending on the Gleason score) potentially active surveillance)

7. Let the urologist know that you plan to seek second opinions and ask him if he can recommend a local oncologist that specializes in prostate cancer. Also, if the doctor recommends surgery, ask him if he can recommend a radiologist that specializes in prostate cancer. If he recommends radiation, ask him to refer you to surgeons that can perform robotic and open radical prostectomy procedures. Have the doctor explain the long time prognosis liklihood between the different options.

8. What is the doctor's opinion of the timeline you have to make a treatment decision? Why?

9. What are the results of the DRE?

10. Are there lifestyle changes (such as diet, exercise, weight loss, etc.) that your father can make that will improve his prognosis?

11. What is the doctor's opinion about hormone therapy and if that is a treatment option?

12. Are there other drugs (such as Avodart) that the doctor feels may be useful at this stage?

Be adamant about receiving complete copies of your father's medical records that include the biopsy report, doctor's notes, lab reports, and so forth. From your GP, you want to get copies of all the lab reports he has had for the last several years (this is where you can get the PSA history readings). Don't leave the office without a copy of your records as you will need them for second opinions and doing your own research.

On the biopsy report, make sure the doctor explains all the technical terms such as PNI, percent involvement, Gleason score for each sample, other suspicious samples that may be in the report, and so forth.

I'm sure there are other things that will come to mind as well. There are several sites on the internet where you can find lists of questions to ask your doctor on these visits. I found it useful to have all of these questions written down and then go through them one-by-one after the doctor finishes talking.

Good luck to you and your father.

K

daughterneedinghelp said:

Thank you both!
Thanks so much for all of that info. I see we have a lot to learn and ask. I will try and get him to call back before his appointment to find out the scores. That should help us understand where we are.
Truly appreciate you taking the time to answer this in such detail for me.
Thank you