CSN Login
Members Online: 7

You are here

Question about Father's Biopsy Report

jetski76
Posts: 13
Joined: Mar 2018

Hello Again,

If you don't mind, I am starting a new thread to ask some questions about my father's prostate biopsy report. Some background (as described in the old thread : https://csn.cancer.org/node/315446)

 1) Father is 81 years old, lives alone in India, was diagnosed with Recurent Urehtral Stricture in 2001 and has been seeing the same Urologist all this time. 

 2) He had complaints of penis pain in December (a 3 on a scale of 10). Urine culture in December showed EColi infection. After antibiotics, the urine culture was clear in January. The ultrasound of his kidney and abdomen in January was normal. His pain switched between 1/10 and 2/10 between Januray and March and when the pain stayed at 2/10 for a few days and did not subside, the Urologist ordered another cystoscopy for March 19. 

 3) Urine and blood tests done on March 17 showed a PSA of 11.22. The urine test also showed bacteria, leucocytes , WBC pus cells: 10-15 (3-5), RBC - 2-4(0-1) and Epithehleal - 1-2 (2-3). 

 4) The last cystoscopy was done in Oct 2016 and PSA at that time was 0.522. All his previous PSA values were between 0.5 and 1.0. He is on antibiotics until March 30.

 5) Last week, he also had a rectal ultrasound that was negative for cancer. His pelvis MRI(1.5 T, T2 + diffusion-weighted, array coil) showed suspicious area on his left hemigland of his prostate. A prostate biopsy was done on March 21. Following is the report and I have some questions after that:

------------------------------------------------------------------------------------------------------------------------------------------------------------------

Histopathology and Cytology

 Histopathology (Small Specimen)

Specimen: Tissue

Clinical Diagnosis: Firm Nodular Prostate, PSA: 11 ng/ml

 Nature of Specimen: Bottle #1: Right Lobe, Bottle #2: Left Lobe

 Gross Morphology 

Bottle labelled as Right: Received multiple, greyish white, linear tissue pieces aggregating to 0.3 cm (All Embed as A)

 Bottle labelled as Left: Received multiple, greyish white, linear tissue pieces aggregating to 0.3 cm (All Embed as B)

 Sections: All Embed (A and B)

 Fixation Time: 24 hours

 Microscopic Description

 Right and Left Lobes: Inflammatory Pathology with small foci of Low Grade PIN

  Impression

 IHC marker Cytokeratin 34 Beta E12 is recommended to rule out Malignancy

  [Gross samples (except All Embed) will be retained for 4 weeks. Blocks & Slides will be retained for 10 years] [Referral Pathology Consultation is an integral part of Quality Assurance]

 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Questions:

 1) The biopsy is recommending IHC marker Cytokeratin 34 Beta E12 to rule out cancer. Does my father need another biopsy for this test?

 2) Given the descriptions in the biopsy report, is it possible to comment if the tissues collected from the prostate were comprehensive? I am asking this because if the biopsy has missed the suspicious areas as indicated in the pelvis MRI, we might have a high grade, undetected prostate cancer growing. Your comments?

 3) How serious is a Firm Nodular Prostate?

 4) With a biopsy report detecting Inflammatory Pathology with small foci of Low Grade PIN, what are the chances of finding prostate cancer in the IHC marker Cytokeratin 34 Beta E12 test?

 5) Given that my father has had a biopsy in the last week and he is taking antibiotics for bacteria in his urine, how long should be the time period before which PSA can be re-tested?

Thank you,

Zent

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Check the PSA two weeks after the end of the antibiotics treatment to draw conclusions, however, the biopsy results so far are negative to cancer. The high PSA could be due to other causes, such as hyperplasia restricting urine flow that could be the cause of the pain.

 

jetski76
Posts: 13
Joined: Mar 2018

Hello VascodaGama,

 Thank you for your reply. It was very helpful. Could you answer the following questions about IHC marker Cytokeratin 34 Beta E12:

1) The biopsy is recommending IHC marker Cytokeratin 34 Beta E12 to rule out cancer. Does my father need another biopsy for this test?

2) With a biopsy report detecting Inflammatory Pathology with small foci of Low Grade PIN, what are the chances of finding prostate cancer in the IHC marker Cytokeratin 34 Beta E12 test?

Thank you

 

 

 

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

I think you should inquire about the details of the biopsy from the urologist. What has he requested from the pathologist's laboratory? Was it to investigate for cancer or type of inflammation?

Pathologists use proper stains to identify malignancy if such is the purposes of the exam. For that extent urologists also label the cores according to the location of the samples, typically taken from 12 or 14 areas. The report above describes two bottles (left and right lobes) with no specifics on the samples. This is unusual and should be further investigated.

The samples can always be reused for additional staining, if necessary.

Please read this;

http://www.harvardprostateknowledge.org/understanding-your-prostate-pathology-report

 

 

jetski76
Posts: 13
Joined: Mar 2018

 

Hello Vasco,

Thank you again!! That link and your reply was very useful in helping me ask questions of both the Urologist and Pathologist tomorrow.

Is it possible to check for cancer in the prostate biopsy tissue samples without doing any immunohistochemistry?  That is, is only a histopathologial test for cancer without doing any immunochemistry on the biopsy tissue samples reliable?

Thank you,

Zent

 

 

 

 

Old Salt
Posts: 720
Joined: Aug 2014

Yes. The pathologist looks at the shape of the cells and assigns a Gleason score to what he sees. 

For instance, Gleason 3: not quite normal

Gleason 5: quite different from normal. 

Just giving examples here; my descriptions are not the 'official' ones that the pathologist uses! You can look up what Gleason 3 cells look like etc.

jetski76
Posts: 13
Joined: Mar 2018

Thank you, Old Salt! That was very helpful.

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

In the meeting with the doctors, I would start by inquiring about the purposes of the biopsy. Typically this involves the identification of the particulars existing/found in the tissue being analyzed. A complete work should include the identification of the type and shape of cells (commented by OldSalt), existing calculi, hyperplasia and any other particulars such as proteins. To do this work pathologists use immunohistochemistry (stains) and check all in a microscope. There are several ways to judge cancer. For instance, with the use of 34bE12 one manages to identify basal cells which are not existent in prostatic cancerous tissues. The high molecular weight cytokeratin 34bE12 reacts with human cytokeratin providing an image as a typical contrast does, therefore identifying basal cells. Etc, etc, etc.

Surely the pathologist is not analyzing the whole tissues of the prostate so that missing cancer is possible. To such extent, biopsies are done with established templates composed of 12 cores (or more) to check at 12 areas that are the most typical affected areas by cancer.

Best,

VG

 

jetski76
Posts: 13
Joined: Mar 2018

Hello Vasco,

Thanks a lot for your detailed reply!! I will follow-up and update once I hear more.

Thank you!!

Zent

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Zent,

I read your entry at your newer thread on the AMACR Staining Test but I prefer to post here my comment as it follows other previous discussions on the same issue.

You wrote this;

           "If a prostate biopsy was negative in the pathology, had a positive staining for p 63 (Immunoreactive, score 4+ in all myoepithelial cells present in all glands), is an AMACR staining test required to rule out prostate cancer?

 

There are close to 25 types of prostate cancer many differentiated by their genes. Cancer is judged when comparing the type of cells, their shape, differentiation and any lack of particulars (components) against a normal cell of the same type. The staining is the quickest and standardized way to identify those differences. The process is complex due to the many variations and surely not a single stain can cover the whole process to a high degree of trust.

Accordingly, pathologists provide their views on a specimen in regards to what they see on the microscope. Surely the more stained the samples get the best the judgment can be done. A trustful test is the one that have been subjected to the full extent of a staining cocktail. It all depends on the efforts done by the pathologist to figure out a conclusion.

This leads many of us to get a second look into the specimen at a different laboratory, in particular when the case seems complex.

Best,

VGama

 

jetski76
Posts: 13
Joined: Mar 2018

 

Hello Vasco,

 

I cannot thank you enough for such a detailed and thoughtful reply!! That was very helpful.

 

Regards,

Zent

jetski76
Posts: 13
Joined: Mar 2018

Hello Vasco,

 Sorry to bother you again! I have a question about my father's persistent penis pain. If you have any insights about it, I am eager to know:

My father first had pain in his penis (a 4 on a scale of 1 to 10) in Dec 2017. His Urologist did a Urine culture and the results indicated EColi infection greater than 10000 CFU/ml. Antibiotics were given and a repeat urine culture in January was normal. 

His pain oscillated between a 1/10 and 2/10 in February and March. He was prescribed a few creams which made the pain manageable. When the pain persisted at 2/10 for a couple of days in the third week of March, the Urologist ordered urine and blood tests (11.22 PSA, positive for bacteria, urine had elevated WBC and leukocytes). A cystoscopy was performed on March 19, which did not find anything abnormal. 

The elevated PSA took us down the path of ultrasound, MRI and biospy. For about a week after his cystoscopy (March 19- March 26), he felt no pain. This might be due to all the NSAID's he was give during his 5 days hospital stay (March 19-March 22). 

His pain returned on April 2 and is currently between 1/10 and 1.5/10. Since the last few days, the pain is felt more in the tip of his penis than shaft. He saw the Urologist on April 9 and wen I emailed his Urologist, he said that the pain will slowly recede. My father has no growth, no discharge, no changes in skin color or redness/rash or anything of that kind on his penis. He has no pelvic pain. His urine stream is fine.

My father had a similar complaint of penis pain in Oct 2016 and a cystoscopy was done in Nov 2016. He had no pain in his penis from Nov 2016 to Dec 2017. So, I am unsure why the pain is persisting so far. 

Questions:

1) Does UTI in December explain the penis pain in Dec-Jan?

2) Does the detected UTI on March 17 explain the penis pain in Jan-March?

3) Since several antibiotics have been given March 17 for his UTI, can the Cystoscopy itself be the cause of his current penis pain due to inflammation of his urethra ?

4) Any other reasons for his persistent pain? I would be grateful for any comments from you.

 

Thank you!!

Zent

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

I've never had such experience. It is better he inquires his doctor.

 

 

 

jetski76
Posts: 13
Joined: Mar 2018

Thank you!

Subscribe to Comments for "Question about Father's Biopsy Report"