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From: Steven L. on 14 Aug 2008 18:10
I have read that prostate biopsy involves about a 25% rate of false
negatives. That is, in 25% of negative biopsies, it turns out that the
patient has prostate cancer after all.

What is current medical practice regarding when a second prostate biopsy
is warranted, to make sure that the first biopsy was not a false negative?

I ask this because I had a prostate biopsy 14 months ago, which was
negative for cancer. But since that time, I've started experiencing
kidney failure too, indicative of a rapidly worsening prostate
situation. That doesn't sound very "benign" to me.


--
Steven L.
Email: sdlitvin(a)earthlinkNOSPAM.net
Remove the NOSPAM before replying to me.
From: Steve Jordan on 14 Aug 2008 18:29
On August 14, Steven L. wrote:

> I have read that prostate biopsy involves about a 25% rate of false
> negatives. That is, in 25% of negative biopsies, it turns out that the
> patient has prostate cancer after all.

If I interpret what S has written, he says that 25% of biopsies report
that there are no PCa cells when there actually are PCa cells in the
prostate.

Sounds to me as if the biopsy simply missed areas that included PCa.
That's why the "sextant" biopsy, which takes only six specimens, is
considered by educated uros to be unreliable. Some uros take 8
specimens. Others take more.

Duke Bahn, MD, uses CDUS (color doppler ultra-sound) exams to determine
which areas should be targeted for biopsy.

> What is current medical practice regarding when a second prostate biopsy
> is warranted, to make sure that the first biopsy was not a false negative?

Seems to me that a continued rise in PSA, as well as other out-of-limits
tests that all too many uros ignore, would give the patient and an alert
medic notice that it's time to redo a biopsy.

> I ask this because I had a prostate biopsy 14 months ago, which was
> negative for cancer. But since that time, I've started experiencing
> kidney failure too, indicative of a rapidly worsening prostate
> situation.

Um, who, exactly, says that kidney failure is "indicative of a rapidly
worsening prostate situation?" And is the "prostate situation" supposed
to be cancer?

Precision in language would be helpful.

I do not intend to be combative or disrespectful.

Regards,

Steve J
From: Alan Meyer on 14 Aug 2008 22:31

"Steven L." <sdlitvin(a)earthlink.net> wrote in message
news:54qdnS-gxtD7MDnVnZ2dnUVZ_sWdnZ2d(a)earthlink.com...
>I have read that prostate biopsy involves about a 25% rate of
>false negatives. That is, in 25% of negative biopsies, it turns
>out that the patient has prostate cancer after all.
>
> What is current medical practice regarding when a second
> prostate biopsy is warranted, to make sure that the first
> biopsy was not a false negative?
>
> I ask this because I had a prostate biopsy 14 months ago, which
> was negative for cancer. But since that time, I've started
> experiencing kidney failure too, indicative of a rapidly
> worsening prostate situation. That doesn't sound very "benign"
> to me.

Steven,

I'm not a doctor and can't give an authoritative opinion. You
need to consult a real doctor or, preferably, a specialist, for
that.

However, it is my impression that kidney failure is unlikely to
be a symptom of early stage prostate cancer.

In the first place, I suspect that prostate cancer doesn't
usually become a problem outside the prostate until it has grown
pretty large in the prostate, which would make is very unlikely
to be missed on a biopsy. I suspect the 25% miss rate, if it's
accurate, mainly happens to men with very small tumors that have
not spread. The miss rate must also, as Steve Jordan said, vary
with the number of biopsy samples taken. It may be that the 25%
rate applies for the old standard of six needle samples but not
for biopsies with more needles (I had 12.)

Secondly, prostate cancer usually metastasizes first to bones,
especially the large bones and joints in the back, shoulders, and
other areas. I _think_ (I'm not sure about this), that a
metastasis to the kidney would not likely occur until after
you've already experienced pain in other areas.

Thirdly, when a significant, symptomatic metastasis outside the
prostate occurs, the PSA usually gets pretty high. Most of the
people I have known who have symptoms of any kind have had a PSA
reading in the hundreds before they noticed any symptoms. I know
one man who had a PSA of 500 and still didn't have any symptoms
(though he was probably an exception.)

So, while it's natural for you to be suspicious of prostate
cancer when you've had a biopsy for it, I would be more concerned
about some cause other than prostate cancer.

As for when a second biopsy is recommended, in the cases where
I've seen it done there was an increasing PSA. If for example a
patient had a PSA of 6 and had a negative biopsy, then a year
later his PSA was 8 or 10, or more, another biopsy might be
recommended.

The usual problem with biopsies is the opposite one from the one
you are worried about. It's not that a significant cancer is
missed, but that an insignificant cancer is found and the patient
panics and demands treatment when, in fact, he doesn't (yet at
least) need it.

Good luck with the kidney problem. Be careful with it and find
yourself a good specialist if you can who can help diagnose it
and plan a treatment.

Alan


From: ron on 14 Aug 2008 22:42
On Aug 14, 8:31 pm, "Alan Meyer" <amey...(a)yahoo.com> wrote:
> "Steven L." <sdlit...(a)earthlink.net> wrote in message
>
> news:54qdnS-gxtD7MDnVnZ2dnUVZ_sWdnZ2d(a)earthlink.com...
>
> >I have read that prostate biopsy involves about a 25% rate of
> >false negatives.  That is, in 25% of negative biopsies, it turns
> >out that the patient has prostate cancer after all.
>
> > What is current medical practice regarding when a second
> > prostate biopsy is warranted, to make sure that the first
> > biopsy was not a false negative?
>
> > I ask this because I had a prostate biopsy 14 months ago, which
> > was negative for cancer.  But since that time, I've started
> > experiencing kidney failure too, indicative of a rapidly
> > worsening prostate situation.  That doesn't sound very "benign"
> > to me.
>
> Steven,
>
> I'm not a doctor and can't give an authoritative opinion.  You
> need to consult a real doctor or, preferably, a specialist, for
> that.
>
> However, it is my impression that kidney failure is unlikely to
> be a symptom of early stage prostate cancer.
>
> In the first place, I suspect that prostate cancer doesn't
> usually become a problem outside the prostate until it has grown
> pretty large in the prostate, which would make is very unlikely
> to be missed on a biopsy.  I suspect the 25% miss rate, if it's
> accurate, mainly happens to men with very small tumors that have
> not spread.  The miss rate must also, as Steve Jordan said, vary
> with the number of biopsy samples taken.  It may be that the 25%
> rate applies for the old standard of six needle samples but not
> for biopsies with more needles (I had 12.)
>
> Secondly, prostate cancer usually metastasizes first to bones,
> especially the large bones and joints in the back, shoulders, and
> other areas.  I _think_ (I'm not sure about this), that a
> metastasis to the kidney would not likely occur until after
> you've already experienced pain in other areas.
>
> Thirdly, when a significant, symptomatic metastasis outside the
> prostate occurs, the PSA usually gets pretty high.  Most of the
> people I have known who have symptoms of any kind have had a PSA
> reading in the hundreds before they noticed any symptoms.  I know
> one man who had a PSA of 500 and still didn't have any symptoms
> (though he was probably an exception.)
>
> So, while it's natural for you to be suspicious of prostate
> cancer when you've had a biopsy for it, I would be more concerned
> about some cause other than prostate cancer.
>
> As for when a second biopsy is recommended, in the cases where
> I've seen it done there was an increasing PSA.  If for example a
> patient had a PSA of 6 and had a negative biopsy, then a year
> later his PSA was 8 or 10, or more, another biopsy might be
> recommended.
>
> The usual problem with biopsies is the opposite one from the one
> you are worried about.  It's not that a significant cancer is
> missed, but that an insignificant cancer is found and the patient
> panics and demands treatment when, in fact, he doesn't (yet at
> least) need it.
>
> Good luck with the kidney problem.  Be careful with it and find
> yourself a good specialist if you can who can help diagnose it
> and plan a treatment.
>
>     Alan

Approximately 70-75% of PCa tumors arise in the the peripheral zone of
the prostate, the zone that is normally probed during biopsy. The
remaining 25-30% of tumors originate in the central and transition
zones, areas not routinely biopsied during a trans-rectal biopsy.
Perhaps this is where the "25% miss rate" comes from...ron
From: len on 16 Aug 2008 20:58
On Aug 14, 5:10 pm, "Steven L." <sdlit...(a)earthlink.net> wrote:
> I have read that prostate biopsy involves about a 25% rate of false
> negatives. That is, in 25% of negative biopsies, it turns out that the
> patient has prostate cancer after all.
>
> What is current medical practice regarding when a second prostate biopsy
> is warranted, to make sure that the first biopsy was not a false negative?
>
> I ask this because I had a prostate biopsy 14 months ago, which was
> negative for cancer. But since that time, I've started experiencing
> kidney failure too, indicative of a rapidly worsening prostate
> situation. That doesn't sound very "benign" to me.
>
> --
> Steven L.
> Email: sdlit...(a)earthlinkNOSPAM.net
> Remove the NOSPAM before replying to me.

I've never heard any direct relation between prostate cancer and
kidney failure.

Kidney failure is possible in some cases for men who have difficulty
urinating because of an enlarged prostate. Although that could happen
because of prostate cancer, it would be unlikely unless the cancer
were pretty far along. In that case, the PSA would most likely be
very high, and a biopsy would be likely to find the cancer.

But that is looking for a fairly exotic explanation, when BPH, just
ordinary benign enlargement of the prostate, if it causes difficulty
urinating and a man ignores it and lets it go long enough, is a more
obvious explanation. My next door neighbor was such a man. He
managed to live for many years on dialysis and died last year at about
83.

I don't know if that is the reason for your kidney problems. There
are many other causes of kidney failure. You should make sure you
discuss the matter thoroughly with your doctors and do what is
necessary to resolve the problem. Ask them whether or not, in your
case, it makes sense to pursue the possibility of prostate cancer any
further at this point. If so, there may be some things they can look
at to increase the likelihood of detection. As Ron notes, they might
change where they probe. They may also check the so-called free PSA
percentage, which, if it is low, may be more indicative of prostate
cancer than BPH. But your primary concern at this point should be
your kidney problems.

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