Re: Prostate Biopsy Meanings?

[Guest guest]

Hi Skip, I am sorry you are going through this, especially after

already having had one cancer, but there is good news. I did a google

search of PIN and found this piece. I thought that it was the easiet

to understand. It was actually in today's online version of

USNews.com. The one thing I noted while reading this is that you said

the VA only took 6 specimens, which is really a pretty outdated way

to do a biopsy these days. Even Kaiser takes 12 cores which is

marginal. Read the second paragraph which speaks of an extended

biopsy, which you certainly did not have. I do hope that this helps a

little bit.

Laurel

Testing and PIN

A prostate biopsy that reveals prostatic intraepithelial neoplasia

(PIN) may leave men unsure of how to react. Although PIN is thought

to be a pre-malignant lesion that has the potential to evolve into

cancer, it is not cancer itself. But certain men with this finding

require careful follow-up because sometimes a second biopsy will

reveal a previously undiagnosed tumor. Approximately 9 percent of men

who have a prostate biopsy in the United States will be diagnosed

with high-grade PIN, which translates to approximately 115,000 men

every year.

There is controversy among experts as to the appropriate follow-up of

men with high-grade PIN. Some studies have shown that men with high-

grade PIN are at higher risk of having prostate cancer and should

undergo a repeat biopsy. However, several well-designed studies

suggest that men with a diagnosis of high-grade PIN have the same

risk of prostate cancer as men who have no abnormal findings on a

biopsy. If a man with high-grade PIN had a well-performed, extended

biopsy that included sampling of the entire peripheral zone of the

prostate, then a repeat biopsy is not mandatory. A reasonable follow-

up plan would be a digital rectal examination and yearly or biennial

testing of PSA levels.

Some evidence suggests that PIN lesions may be part of a multistep

process that leads to invasive prostate cancer since PIN shares many

of the genetic hallmarks of " true " prostate cancer. Men with high-

grade PIN should continue to have their PSA levels checked and

undergo periodic prostate exams. They should also keep their weight

under control, exercise regularly, and eat a low-fat diet rich in

fruits, vegetables, and fiber.

>

> I had a Prostate Biopsy done on Nov 03,2008 by the VA Medical

Center in

> Sacramento, CA. The question I have is, I had 6 specimans taken

and

> they all showed ACUTE & CHRONIC INFLAMMATION / ATROPHY & one showed

> HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA IS IDENTIFIED.

>

> The VA called last Wednesday & I call back 4 times without a call

back

> from them in SAC. Today I went to our VA Clinic here in Redding,

CA

> and got a copy of the results which I should not had to do. Anyway

> could some one explain what this means. By the way, I happen to be

62

> years old and am inconinent 24/7. And I was exposed to Agent

Orange in

> Vietnam (I Corp 1966-68)

>

> Thanks for your help and I'm scared - I had Colon Cancer 6 years

ago

> and they took a third of my colon and I have been cancer free since

> then.

>

> Skip

> skiparope@...

>

[Guest guest]

J. (Skip) Glenfield wrote:

> I had a Prostate Biopsy done on Nov 03,2008 by the VA Medical

> Center in Sacramento, CA. The question I have is, I had 6

> specimans taken and they all showed ACUTE & CHRONIC

> INFLAMMATION / ATROPHY & one showed HIGH GRADE PROSTATIC

> INTRAEPITHELIAL NEOPLASIA IS IDENTIFIED.

....

Skip,

I found an article on the web that discusses this diagnosis.

See: http://www.emedicine.com/med/topic3056.htm

It's very technical and I don't pretend to understand it all,

but my impression from the article is:

1. No cancer was found. HGPIN can be a precursor to cancer but

is not itself cancer.

2. Your chance of developing cancer is higher than if you didn't

have HGPIN.

3. No treatment is required for HGPIN.

4. You should be checked periodically in the future because you

are at higher risk for prostate cancer than the average man.

As for the inflammation and atrophy, I suspect that means that

you have prostatitis (which means inflammation of the prostate).

If you've had an elevated PSA, prostatitis might be the cause.

In the future, if you ever get another biopsy, you should

probably get a 12 needle biopsy rather than a 6 needle

biopsy. I'm not an expert, but it's my understanding that

current practice in urology uses 12 or even more needles.

Good luck.

Alan

[Guest guest]

J. (Skip) Glenfield wrote:

> I had a Prostate Biopsy done on Nov 03,2008 by the VA Medical

> Center in Sacramento, CA. The question I have is, I had 6

> specimans taken and they all showed ACUTE & CHRONIC

> INFLAMMATION / ATROPHY & one showed HIGH GRADE PROSTATIC

> INTRAEPITHELIAL NEOPLASIA IS IDENTIFIED.

....

Skip,

I found an article on the web that discusses this diagnosis.

See: http://www.emedicine.com/med/topic3056.htm

It's very technical and I don't pretend to understand it all,

but my impression from the article is:

1. No cancer was found. HGPIN can be a precursor to cancer but

is not itself cancer.

2. Your chance of developing cancer is higher than if you didn't

have HGPIN.

3. No treatment is required for HGPIN.

4. You should be checked periodically in the future because you

are at higher risk for prostate cancer than the average man.

As for the inflammation and atrophy, I suspect that means that

you have prostatitis (which means inflammation of the prostate).

If you've had an elevated PSA, prostatitis might be the cause.

In the future, if you ever get another biopsy, you should

probably get a 12 needle biopsy rather than a 6 needle

biopsy. I'm not an expert, but it's my understanding that

current practice in urology uses 12 or even more needles.

Good luck.

Alan

[Guest guest]

J. (Skip) Glenfield wrote:

> It has been a little while since I've written.... I have been

> told that I should have another Biopsy done in about 6 months.

> Well it's been about 6 months & what does the gang say?

....

> > I had a Prostate Biopsy done on Nov 03,2008 by the VA Medical

> > Center in Sacramento, CA. The question I have is, I had 6

> > specimans taken and they all showed ACUTE & CHRONIC

> > INFLAMMATION / ATROPHY & one showed HIGH GRADE PROSTATIC

> > INTRAEPITHELIAL NEOPLASIA IS IDENTIFIED.

Skip,

As I understand it, the inflammation you had is prostatitis,

which might be causing some symptoms and also elevating your PSA.

The PIN is a tissue change that is like cancer but not cancer.

Again, as I understand it, PIN may be a precursor to cancer.

I think that what you need more than anything else right now is

access to a good urologist whom you can trust. A good doctor

could tell you what the inflammation and the PIN mean, and can

give you better advice than we can as to whether another biopsy

is indicated.

I would think that the VA should be testing your PSA regularly.

A PSA test is very cheap and non-invasive as compared to a

biopsy. It can give you some information, though not as much as

a biopsy could.

I recommend that you ask the VA to give you a consultation with a

urologist. The urologist should send you for a PSA test and any

other tests he recommends BEFORE your appointment, so that when

you see him he'll have all the results in hand. You should also

insist that the results of the biopsy be in the hands of the

urologist by the time of the appointment. The best way to do

that is probably to get a complete copy of the biopsy report (not

just the one sentence conclusion) and take it to him when you go.

Don't leave it in his office. If he wants to keep it, ask him to

make a copy. You don't want your copy to get lost.

It looks like you may have to battle the VA. Failing to send you

the biopsy result after multiple requests is pretty bad. Failing

to give you an appointment with a specialist to explain those

results is also bad. You may have to fight a bit.

There is some good news in all of this. You didn't show any

cancer the last time you were checked for it. Prostate cancer is

usually very slow growing and is often very treatable in its

early stages. I think the odds are good that if you are

developing cancer, you've found out very early and have a good

chance to beat it - as you did with the colon cancer.

Good luck.

Alan