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Could someone unconfuse me..........

Posts: 1
Joined: Jun 2011

I live in the UK.
We have Public (free) Medical Services.
The following is my recent Prostate Medical History
April 2010
A & E – Urinary Retention
Overnight stay - Catheterised
DRE - normal but enlarged - Initial Diagnosis - BPH
Prescribed: Tamsulosin (Flowmax)
No subsequent issues
Follow up - July/August 2010
Urology Clinic - Urodynamics - Flow Tests etc.
Normal - Discharged - File Closed - No PSA tests
October 2010
DRE- normal – prostate enlarged
Suggested PSA Test
Arranged General Blood Test + PSA
GBT - normal - forgot the PSA Test
Re arranged PSA Test - November - Result lost
December 2010
PSA Test: Result 25.6
DRE - normal – prostate enlarged
Urgent Referral to Hospital Urology Department
January 2011
Hospital Urology Department
Urodynamic Flow Test - ok
DRE - normal – prostate enlarged
Advised Biopsy
January 2011
Hospital Urology Department
12 Core Trans Rectal Biopsy
January 2011
Hospital Urology Department
Pathology result: no evidence of PCa - only HG PIN
Suggested additional PSA Test in 2/3 months - followed by Saturation Biopsy
March 2011
PSA Test: Result 25.9 - no significant difference
Suggested GP advise Urology & request a MRI prior to any further Biopsies
April 2011
Hospital – 3T MRI Scan
April 2011
Hospital Urology Department
MRI result - a little vague - "indications” of - tumour within prostate & possibly enlarged seminal vesicle & obturator lymph node
Suggested targeted Saturation Biopsy should clarify everything
April 2011
Hospital Urology Department - Day Surgery Centre
Trans Perineal Saturation Biopsy
May 2011
Hospital Urology Department
Pathology result: 48 cores of prostate & seminal vesicles
59 samples tested - no evidence of PCa
Was asked to empty my bladder & ultra sound test revealed "fully emptied".
Was told that if Bladder not emptied they would have recommended a TURP
as this could take further samples that could be analysed for PCa from the
transition zone.
No further proposals currently other than further PSA test in 3 months with possible additional MRI after Biopsy inflammation has died down.

I am totally confused about my position as I am in the category generally
considered High Risk due to PSA & MRI "Indications" - but there is no resolution of the problem – yet……

VascodaGama's picture
Posts: 1780
Joined: Nov 2010


You are confused but you are not alone. I really hope that you are cancer free.
My opinion as a layman is that your doctor thinks that you have cancer but he cannot find it. You should however be cautious and research about the problem.

There have been several reported cases in which the PSA is high but negative to cancer in biopsy. BPH can be the culprit behind the high PSA however; inflammation of the prostate causes relevant variations (ups and downs) of PSA which you are not aware of because you have no past history of tests.

In similar cases to yours it is typical to repeat the biopsy. The HG-PIN you commented, may have been an “alarming bell” that caused your doctor to request you for a Transperineal Saturation Biopsy instead of the traditional 12/18 cores biopsy, because it can reach hidden areas of the prostate that are difficult to counter with a transrectal biopsy. You can read about that here;

To understand the importance of your diagnosis of PIN, you need to research about the cancer itself. Usually the typical prostate cancer cell is classified under the Gleason pattern “scale” which goes from 1 to 5 in aggressivity. Pattern 1 and 2 are quite similar in shape and characteristics to non-cancerous cells. Some can be confused with PIN cells (prostate intraepithelial neoplasia) which are found in the tissue lining the prostate. These are abnormal cells and have been strongly linked to prostate cancer. Here is a good site about PIN with reference from Dr. Jonathan Epstein who is one of the best in regards to biopsy analyzes of prostate cancer.

In another site they say this;

“..HG-PIN is defined as a pre-malignant lesion present in most cancerous prostates. Although a pre-malignant lesion shows many of the typical cellular changes observed in cancer, the lesion has not yet progressed fully to disease. Since HG-PIN lesions are also associated with the presence of cancer in many patients, men whose biopsies show HG-PIN are often re-biopsied until cancer is detected…”


You could get a second opinion on your biopsy at the JH and you could do other tests to rule out cancer. Some types of prostate cancer do not produce PSA which makes them “invisible” to the routine cancer prevention.
(Read this; http://webreprints.djreprints.com/2458281207480.pdf)

A typical test done to similar cases in Europe is the urine test named “PCA3” which is regarded as more accurate than PSA in the diagnosis of prostate cancer. You can read about that here;

Other important tests are the % free PSA, PAP, or tests involving genetics such as; human aspartyl (asparaginyl) beta-hydroxylase (HAAH), EGFR, etc.

I hope this helps in your confusion (in the good sense).

Wishing you peace of mind.
Welcome to the board.


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