Another new guy trying to understand

tommyg1951
tommyg1951 Member Posts: 13
edited October 2016 in Prostate Cancer #1

Greetings everyone - I have been reading here today and I like the attitudes of everyone so I thought I would throw out my question.

I had a Biopsy done back in 2014 when my PSA was 4.6 - a segment of the report is shown below:

Clinical History / Pre-op Diagnosis: Elevated prostate specific antigen (PSA) Specimen(s)Received:

1: Prostate, needle biopsy (Lt. Base)

2: Prostate, needle biopsy (Lt. Mid)

3: Prostate, needle biopsy (Lt. Apex)

4: Prostate, needle biopsy (Rt. Base)

5: Prostate, needle biopsy(Rt. Mid)

6: Prostate, needle biopsy (Rt. Apex)

Gross Description: All containers labeled "xxxxxxx, Thomas".

1. "LT base" Two cores, 13 and 17 mm, and fragments. AP/1c.

2. "LT mid" Two cores, 14 and 16 mm, and fragments. AP/1c.

3. "LT apex" Two cores, 15 and 16 mm, and fragments. AP/1c.

4. "RT base" Two cores, 18 and 22 mm, and fragments. AP/1c.

5. "RT mid" Two cores, 19 and 21 mm, and fragments. AP/1c.

6. "RT apex" Three cores from 9-12 mm and fragments. AP/1c.

 

NL meg/10/22/2014 

PSA was retaken last week and has jumped to 5.7 so the Urologist is recommending an MRI (not sure what kind of MRI though). I should get an appointment call tomorrow I hope.

Anyway - I am wondering what the "AP/1c" portion of the pathology report is all about. I tried to look it up here (http://stedmansonline.com/webFiles/Dict-Stedmans28/APP21.pdf) but it makes about as much sense to me as if I were to try explaining some of my COmputer Network Administrator jargon to a lay person.

Any help is appreciated.

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Comments

  • tommyg1951
    tommyg1951 Member Posts: 13
    edited October 2016 #2
    Is this showing up?

    Testing 1 2 3 4 5

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,721 Member
    Welcome

    Yes, Tommy, your posts are going out. And welcome to you here.

    At first, I did not think that " AP/1c " was a result at all, and it might not be.  I do not know the term within the context of biopsy results.

    Someone soon surely will, or ask for an explanation when you go for your pending appointment.  Six cores having exactly the same results is virtually unheard of if there is cancer however.  The closest thing I could find was "Abnormal Prostate," but do not assume this. The article stated that as used it referred to "atypical, unspecifiable cell clusters."  I stress: this may or may not be what the term means on your report.

    Good luck with your MRI.

    max

     

  • tommyg1951
    tommyg1951 Member Posts: 13
    Thanx Max

    I will be asking for sure the next time I see the Doc - but I just thought there might be an explanation out there. Keep up the great work - maybe someday - I will be able to answer someone elses posts as well. Thanks again!

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,721 Member

    Thanx Max

    I will be asking for sure the next time I see the Doc - but I just thought there might be an explanation out there. Keep up the great work - maybe someday - I will be able to answer someone elses posts as well. Thanks again!

    Already Do

    I hope so Tommy, I suspect some guys have already benefitted somehow from what you asked about.

    None of us are doctors or medical authorities, just guys sharing what we have been through and learned.

    I tell people accurately that I 've had no medical training, I've just had every medical thing.

    .

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    edited November 2016 #6
    Activator Protein-1c (AP-1c)

    Hi Thomas, (your name is printed in the report)

    I think it better for you to inquire with your doctor regarding the biopsy results. The expression of your question "Activator Protein-1c (AP-1c)" refers to aDNA-binding factor typically found in benign hyperplasia but not in cancer. This may signify that all 12 cores had expressions of AP-1 meaning high probability for negative to cancer. I wonder if you are experiencing any problem regarding urination (frequency, retention, etc) that could be a cause of hyperplasia.

    Here is a link of interest to you;

    https://www.ncbi.nlm.nih.gov/pubmed/12913698

    Best wishes and hope you do not become a member of this club.

    VGama

     

  • tanstaafl
    tanstaafl Member Posts: 1,299 Member
    IRL details

    Thanks for all that detail on the cores.   Any experiences to share on billing, costs and claims ? 

  • tommyg1951
    tommyg1951 Member Posts: 13

    Activator Protein-1c (AP-1c)

    Hi Thomas, (your name is printed in the report)

    I think it better for you to inquire with your doctor regarding the biopsy results. The expression of your question "Activator Protein-1c (AP-1c)" refers to aDNA-binding factor typically found in benign hyperplasia but not in cancer. This may signify that all 12 cores had expressions of AP-1 meaning high probability for negative to cancer. I wonder if you are experiencing any problem regarding urination (frequency, retention, etc) that could be a cause of hyperplasia.

    Here is a link of interest to you;

    https://www.ncbi.nlm.nih.gov/pubmed/12913698

    Best wishes and hope you do not become a member of this club.

    VGama

     

    Thanks VGama

    Good to know about the DNA-binding factor. As far as I can tell though - there were only 6 cores taken as shown in what I posted. I left out nothing except my full name and the doctor's name. BTW - it's been a week now and I still don't have an appointment foe the MRI. If no call by tomorrow I will call the Doc's office. Waiting simply sucks.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Thanks VGama

    Good to know about the DNA-binding factor. As far as I can tell though - there were only 6 cores taken as shown in what I posted. I left out nothing except my full name and the doctor's name. BTW - it's been a week now and I still don't have an appointment foe the MRI. If no call by tomorrow I will call the Doc's office. Waiting simply sucks.

    T3 MRI

    Suggest that you ask for a T3 MRI, which provides high resolution, it's an MRI with a Tesla 3.0 magnet. This MRI uses the highest magnet in clinical use, and will be more effective for you than other MRI's.

    Generally a 12 core biopsy random biopsy is recommended. You may wish to inquire with the urologist.

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    edited November 2016 #10
    So far no positive indication of cancer

    Thomas,

    Your list above specifies 13 (5x2+1x3) cores. I counted 12 because it is the typical template used in biopsies. In my times Sextants were typical but these are out-of-mode now. The third core from the Right Lobe Apex (RT apex) could have been added by the urologist when shooting the gun if he has seen on the ultrasound screen something obscure in the area. Tissue at each core is measured in length and multiplied by the cores diameter of <1 mm to obtain the volume of found cancer, if any. These measurements are indicated in the list.
    LT=Left Lobe; RT= Right Lobe; The zones of the prostate: Base (just under the bladder), Mid (middle zones) and Apex (the lower zone where most cancers are found, therefore a good justification for the three cores taken).

    Pathologists identify all types of existing tissues as well as conditions (such as hyperplasia, calculi, etc) and report on findings, but it only analysis what has been requested by the urologist. Longer analysis with more staining mean higher charges. The report you typed above is short in its description and only indicates investigations on the cells. I wonder if the examination of 2014 had a different purpose instead of looking for cancer.

    Can you tell us what made you to have the biopsy back in 2014?

    Were you experiencing any urination problem leading to suspicious case of hyperplasia?

    Was there any symptom apart from the PSA= 4.6 ng/ml?

    The above report does not identify the type of tissue (benign or cancer). Either the urologist at that time placed an order for analysis on hyperplasia (making it simple) or this report has a complementary attachment with the details which copy was not given to you.
    I think it better for you to inquire on the above in your next consultation. The MRI will add more information on the area and it is good in having a picture that can be useful for judgments now and serve as comparison data for future needs.

    Waiting is terrible when we are imagining the worse. However, you have not been declared a PCa patient yet (no report and no picture) and the high PSA could be a cause of hyperplasia, sex, riding a bike, etc. A positive diagnosis would not mean the end of the world. There are many ways to deal with the bandit.

    Take each day at a time and enjoy the beauty of life with quality and less worries.

    Best wishes,

    VGama

  • tommyg1951
    tommyg1951 Member Posts: 13
    Dr. thought biopsy was routine @ 4.6

    No other symptons to my knowledge - I do urinate frequently (3-4 times nightly). Last year PSA was 4.8 so the jump to 5.7 is prompting him to go for the MRI. He said it was a very strong MRI. After reading so many other stories here - I am seeing some of you with 26 psa or higher - makes me wonder if we are getting too excited too early over this. Any thoughts? And again - thanks to everyone for the input. (IRL Details - - all was covered by insurance so I don't know from two years ago.)

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    edited November 2016 #12
    Many things can elevated the PSA

    You can inquire on details in your next consultation. I just wonder if some other test/examination was done in 2014 to trigger the biopsy. Did you get a DRE or any CT with suspicious findings?

    The PSA varies with the age of the patient. It also depends on the type of cells (some produce more stuff than others) and the cause. Big size prostates also produce more serum and so do cases of hyperplasia or inflammation. Typically doctors recomment a protocol of UTI medication to try finding a reason for any increase before advancing with a biopsy. Routine biopsy due to PSA=4.6 is not a standard. In any case do not worry so much. Prepare a list of questions while waiting.

    Enjoy.

    VG

     

  • Clevelandguy
    Clevelandguy Member Posts: 750 Member
    Hi

    My general practice MD told me he had a guy with a PSA around 2.5 that was increasing, did the biopsy and found cancer so it's not just about the number.  It's more about the rate of PSA increase that should trigger your doctors.  I was alway told that anything above 4 should be of a concern. Keep an eye on how fast the PSA is increasing(that's what my doctor did) and that could tell you that something might be going on with your prostate. Mine climbed from the general 2 area to just over 6 when my doctor got concerned, it took about 5 years for it to go to the 6 range.

    Dave 

    3+4

  • tommyg1951
    tommyg1951 Member Posts: 13
    It's been just over a month . . .

    I couldn't have the MRI done because I have some stents that could not be verified as to their material. (They are around ten years old or more and no records.) So the Doc had a repeat PSA two days ago and I met with him today. In the last thirty days my PSA has jumped from 5.7 to 6.2 - so he has scheduled a biopsy for Jan. 5th. Dr. told me today that he did the first biopsy when my PSA was at 3.7 (I earlier thought it was @ 4.2 - oops). Nothing was found back then but now I am 2.5 points higher. Getting a little worried - OK - worried. Thanks one and all for being here and all your previous comments. I will keep posting how things go with the next biopsy.

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,721 Member
    edited December 2016 #15
    Hi

    Welcome back after about a month, Tommy.

    Your doctor is correct to do another biopsy now, especially since the MRI cannot be performed.  Your PSA vector warrants further testing.

    You mentioned being worried, which is unavoidable. Just don't take the further step into fear.  If cancer is detected this time your cancer is still very likely quite minor.

    As has been discussed, there are no absolute PSA thresholds that prove much of anything regarding PCa. What does exists are numbers and trends that reasonably demand follow up. Let us know she results,

    max

  • tommyg1951
    tommyg1951 Member Posts: 13
    edited December 2016 #16

    Hi

    Welcome back after about a month, Tommy.

    Your doctor is correct to do another biopsy now, especially since the MRI cannot be performed.  Your PSA vector warrants further testing.

    You mentioned being worried, which is unavoidable. Just don't take the further step into fear.  If cancer is detected this time your cancer is still very likely quite minor.

    As has been discussed, there are no absolute PSA thresholds that prove much of anything regarding PCa. What does exists are numbers and trends that reasonably demand follow up. Let us know she results,

    max

    I agree

    But I guess that's the wonderful part about being human. We worry - sometimes too much. I will watch out for that threshold for fear. Thanks-

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    Saturated Biopsy

    Thomas,

    I am pleased of knowing that the doctor confirmed our discussions above regarding the biopsy of 2014. In any case, the latest PSA is suspicious and the trend (constant increases: 3.7/4.2/5.7/6.2 .....) is typical of PCa cases. I absolutely agree with Max suggestions; the biopsy is the way to proceed to verify and recheck the doubts from 2014. I understand yours feelings but I am sorry to say that I see your case to become more complicated if cancer is not detected this time. Without a proper justification on the continuous increase one is never free of the worries.

    I sincerely would prefer to tell you for not worrying but I believe it proper to inform you about similar cases of negative biopsies in the presence of unexplained constant PSA increases. These guys had to go through Saturated Biopsies (24 or more cores) to confirm a positive diagnosis. I wonder if you should discuss on such a possibility with your doctor this time because of the negative result of 2014. The info you share in your last post above and your symptomless status seems to confirm that the PSA of 2014 (3.7 ng/ml) was highly suspicious of cancer. Maybe your doctor could/should aim the gun to different regions in the prostate this time (so that you can avoid a saturated biopsy).

    Can you share your age and other health issues you have or aspects (medications) that you are taking? Was hyperplasia ever mentioned?

    These links explain details on Saturated Biopsies;

    https://www.bcidaho.com/providers/medical_policies/sur/mp_701121.asp

    http://www.medscape.org/viewarticle/711721_2

    No matter what one may think, you are not a member of this unwanted club yet.

    Best wishes,

    VGama

  • tommyg1951
    tommyg1951 Member Posts: 13
    edited December 2016 #18

    Saturated Biopsy

    Thomas,

    I am pleased of knowing that the doctor confirmed our discussions above regarding the biopsy of 2014. In any case, the latest PSA is suspicious and the trend (constant increases: 3.7/4.2/5.7/6.2 .....) is typical of PCa cases. I absolutely agree with Max suggestions; the biopsy is the way to proceed to verify and recheck the doubts from 2014. I understand yours feelings but I am sorry to say that I see your case to become more complicated if cancer is not detected this time. Without a proper justification on the continuous increase one is never free of the worries.

    I sincerely would prefer to tell you for not worrying but I believe it proper to inform you about similar cases of negative biopsies in the presence of unexplained constant PSA increases. These guys had to go through Saturated Biopsies (24 or more cores) to confirm a positive diagnosis. I wonder if you should discuss on such a possibility with your doctor this time because of the negative result of 2014. The info you share in your last post above and your symptomless status seems to confirm that the PSA of 2014 (3.7 ng/ml) was highly suspicious of cancer. Maybe your doctor could/should aim the gun to different regions in the prostate this time (so that you can avoid a saturated biopsy).

    Can you share your age and other health issues you have or aspects (medications) that you are taking? Was hyperplasia ever mentioned?

    These links explain details on Saturated Biopsies;

    https://www.bcidaho.com/providers/medical_policies/sur/mp_701121.asp

    http://www.medscape.org/viewarticle/711721_2

    No matter what one may think, you are not a member of this unwanted club yet.

    Best wishes,

    VGama

    Thanks VG

    Age 65 - diabetic (insulin and Metformin) - Coronary Artery Disease (6 stents) Plavix, Atorvastatin, Aspirin - High Blood Pressure Losartan, Amlodapine. There has been no discussion of hyperplasia. I just looked at the links you sent and then via our "Patient Portal" asked the Urologist if a "Saturated Biopsy" would be beneficial at this stage.

    Again - thanks - it is great having such a suppport forum as this.

  • Old Salt
    Old Salt Member Posts: 899 Member
    edited December 2016 #19
    Good question to ask

    I am glad you followed up on Vasco's advice.

    As an aside, make sure that all medical people who will be dealing with you are aware of your other health issues, including the drugs you are taking.

    Sorry if this is obvious, but preventable medical mistakes do happen

  • Charlesaw57
    Charlesaw57 Member Posts: 1

    Dr. thought biopsy was routine @ 4.6

    No other symptons to my knowledge - I do urinate frequently (3-4 times nightly). Last year PSA was 4.8 so the jump to 5.7 is prompting him to go for the MRI. He said it was a very strong MRI. After reading so many other stories here - I am seeing some of you with 26 psa or higher - makes me wonder if we are getting too excited too early over this. Any thoughts? And again - thanks to everyone for the input. (IRL Details - - all was covered by insurance so I don't know from two years ago.)

    Doctor wants me to start Harmone shots,

    My doctor tells me I need harmond shots, after taking out 11 Lymnos 1 had 2.3 cm of cancer on it out of the 11, he wanted me to start the shots right away. I never got a test to show the cancer had spread, after prostrate Surgery my PSA is now undetectable, but after sending it to the lab the doctor wants me to have harmone shots for 2 years, but tells me more poeple live longer that get the shots and it's small now, it's best to get the shots now while it's jsut 2.3 cm then to fight it later.  HELP ME PLEASE THIS IS MY FIRST EVER AND I'M TRYING TO BE BRAVE IN FRONT OF MY WIFE BUT I'M WORRIED, i DON'T KNOW WHATS BEST AND WHAT TO DO, I DO WANT TO GET ANOTHER OPINION, ANY HELP OR INFOR WOULD BE APPRECIATED.

  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    edited December 2016 #21

    Doctor wants me to start Harmone shots,

    My doctor tells me I need harmond shots, after taking out 11 Lymnos 1 had 2.3 cm of cancer on it out of the 11, he wanted me to start the shots right away. I never got a test to show the cancer had spread, after prostrate Surgery my PSA is now undetectable, but after sending it to the lab the doctor wants me to have harmone shots for 2 years, but tells me more poeple live longer that get the shots and it's small now, it's best to get the shots now while it's jsut 2.3 cm then to fight it later.  HELP ME PLEASE THIS IS MY FIRST EVER AND I'M TRYING TO BE BRAVE IN FRONT OF MY WIFE BUT I'M WORRIED, i DON'T KNOW WHATS BEST AND WHAT TO DO, I DO WANT TO GET ANOTHER OPINION, ANY HELP OR INFOR WOULD BE APPRECIATED.

    Charles; HT can be started at any time

    Charles

    It is better to start your own thread. Many here will help you understanding the facts involving your concerns. However, you need to share more details of your case/story for us to understand your status.
    Hormonal shots/treatments (HT) are typical in prostate cancer but one should take them if in fact it improves the situation. HT causes side effects that may be unpleasant to many. Please tell us your age, symptoms, PSA histology, Gleason grade, results of image studies (bone scan, CT, MRI, etc).

    Do not panic. Things can be solved. You do not need to follow your doctor's suggestion if not confident with his advice. HT can be started at any time.

    Best wishes,

    VG