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Pathology/Prostate Biopsy and MRI results

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Hi Dr. Dahiyn,

The following are my husbands prostate biopsy results done 12/14 and MRI done 7/28/15.  We are trying to control the cancer naturopaathically. Can you tell me if it has changed since biopsy, and also your suggestions based on mri?  Watchful waiting? I tried to copy and paste as best I could.  You have helped me in the past.  My husband had kidney cancer in 2007.  Thank you in advance.

Biopsy
Prostate Biopsy Pathology Report / FINAL
PATIENT INFORMATION
Male. Age: 69 I 008:5/12/1945 | EMR: #96209
PHYSICIAN INFORMATION
Joseph C Cam bio, MB
Ufoiogical Specialists of New England
725 Reservoir Ave, Suite 104
CRANSTON, Rl, 02910
ACCESSION NUMBER
14AS023628
DATE COLLECTED: 12/16/2014
DATE RECEIVED: 12/20/2014
DATE REPORTED: 12/23/2014
PHONE: (401| 2 7 5 - 8 1 1 0 FAX: ( 4 0 1 ) 8 2 8 - 7 5 3 8
Clinical Information: PSA: 6.7S. ng/mL 10/23/2014 | Clinical Stage: None Provided
P R O S T A T E BIOPSY D I A G R AM M I C R O G R A P H S
LEGEND
C Malignant A Atypical / Suspicious H HGP1N
I See Notes X Extraprostatic Extension P Perineural Invasion
DIAGNOSIS
Specimen Site Diagnosis Gleason Score % Involved Tumor Length Core Length (mm) Fragments
1. Left Base Benign 14 1
2. Left Mid Benign 20 1
3. Left Apex Adenocarcinoma ! (3+3)6 <5% <1 mm 20 1
4. Left Lateral Base Benign 12,3,2,1,1 5
5. Left Lateral Mid Benign 15,1 2
6. Left Lateral Apex Benign 6,4,4 3
7. Right Base Adenocarcinoma ! P (3*4)7 70% 2.2.4 mm 18,14 2
8. Right Mid Adenocarcinoma (3+4)7 5 6% 9 mm 18 1
9. Right Apex Adenocarcinoma (3+4)7 5% 0,8 mm 15,1 2
10. Right Lateral Base HGPIN 10 1
11. Right Lateral Mid Adenocarcinoma ! P (3+4)7 5% 1 3 mm 16,10 2
12. Right Lateral Apex Benign 20 1
DIAGNOSIS S J O T ES
3. The diagnosis of carcinoma is supported by the failure of immunoperoxidase staining for high molecular weight cytokeratin
and p63 to demonstrate basal cells in the atypical glands. Also favoring the diagnosis of cancer is that staining for racemase (a
marker preferentially expressed in prostate cancer) is positive. All positive and negative controls show proper staining.
Specimens #3 and #7 have been reviewed by another pathologist and agrees with the above diagnoses.
7. Adenocarcinoma involving 2 of 2 cores.
PTEN molecular testing is being performed on this case on specimens #7A, 8A and 9A. ERG molecular testing is being performed
on this case on specimen #7A.The results of the PTEN,ERG prognostic assay will be sent under separate cover upon completion.
11. Adenocarcinoma discontinuously involving 2 of 2 cores.

SECOND PART OF REPORT

Metamark, Inc. 985 Broad Street, Suite A, Augusta, GA 30901 Phone   www.metamark.us
PATIENT INFORMATION SPECIMEN ID #: 14APN07202 PHYSICIAN
Date Collected: 12/16/2014 Primary Physician: Joseph C. Cambio, MD
DOB: 5/12/1945 Date Received: 12/24/2014 Client: Urological Specialists of New England
Patient 3: 14-354-006 Date Reported: 1/6/2015 Client U: CL2129
wooERAre
This result places this cancer in a category of MODERATE RISK and predicts the shortest lime to biochemical
recurrence. Clinical intervention is a decision best left to the clinician and the patient.
These findings should be considered as an adjunct to other clinico-pathological findings including but not
limited to Gleason score and number of cores involved by carcinoma.
DIAGNOSIS - PTEN
Positive for Hemizygous PTEN deletion in >= 30% of t he ceil nuclei. There were 35 out of 50 cells analyzed that demonstrated a hemizygous deletion for the PTEN region.
Fusion Not Detected. Although the ERG fusion was not detected in this sample, many cells appeared to contain multiple copies
of theTMPRSS2/ DSCAM/HMGN1/ERG gene regions.
Both PTEN 3nd TMPRSS/ERG, fluorescent in situ hybridization tests were developed and their performance characteristics determined by Metamark. It has not
been chared or approved by the U.S. Food and Drug Administration. The FDA has determined that such approval is not necessary. This test is used for clinical
purposes. It should not be regarded as investigational or for research. Metamark is certified under Clinical laboratory Improvements Amendments of 1988 (CLIA)
as qualified to perform high complexity clinical laboratory testing.
GROSS DESCRIPTION
Source Blocks / Slides Biopsy ID
Tissue 14AS023628 7A: Right Base; 8A: Right Mid; 9A: Right Apex
COMMENTS
FISH assay results may not be informative if the specimen quality and/or specimen slide preparation is inadequate. A rigorous quality check should be performed
when selecting slides for FISH.
Genetic mutations of PTEN are observed in up to 60% of prostate cancers 1-3. Loss of PTEN is a significant prognostic marker that has been shown to be associated
with poor clinical outcome as measured with biochemical reoccurrence. Homozygous deletion (loss of both copies of the PTEN gene) demonstrates a shorter time to
recurrence when compared to hemizygous deletion (loss of one of two gene copies of the PTEN gene).
There is a statistically significant association between TMPRSS
2:ERG fusions and prostate cancer specific metastases or death.

In a Multivariate analysis, having
TMPRSS2:ERG fusion with a concomitant PTEN loss appears to be an additional determinant of the phenotype that governs a more aggressive tumor phonotype. 4

MRI
HISTORY: Recently diagnosed prostate malignancy.
Prostate biopsy result: Adenocarcinoma left apex Gleason 3+3 = 6; adenocarcinoma right base, right mid gland,
right apex all Gleason 3+4 = 7; adenocarcinoma right lateral mid gland Gleason 3+4 = 7; right lateral base
high-grade prostate intraepithelial neoplasia.
PSA: 5.34ng/mL

TECHNIQUE: Multiplanar T l and T2-weighted images of the prostate obtained at 3T without an endorectal
coil. Intravenous contrast was not given due to renal insufficiency. 0.5 mg glucagon administered IV, 0 mL
discarded as waste.

COMPARISON: There is no prior study for comparison.

FINDINGS:
The prostate gland measures 5.1 x 4.1 x 4.0 cm.
The calculated prostate volume is 42.5 cc.
There is a nodular focus of restricted diffusion in the right mid gland extending to the right apex and measuring
1.0 x 1.0 x 1.5 cm consistent with known adenocarcinoma in this location. Smaller foci of signal abnormality are
present within the right base as well as the right lateral base. No discrete abnormality present within the left
gland. There is mild central gland hypertrophy.
No extracapsular tumor is identified. The seminal vesicles appear normal. There is no suspect lymphadenopathy
or suspicious bony lesions. Incidental note is made of a large septated right-sided hydrocele partially visualized.

IMPRESSION:
MRI findings of confined prostate cancer without extracapsular tumor, seminal vesicle invasion, suspect
adenopathy, or osseous metastatic disease. Large septated right-sided hydrocele partially visualized.
Electronically signed on 7/28/15 4:19 PM John Pezzullo, M.D. Pager: (401) 350-9882

Answer
Hello MaryAnn:

My sincere apologies to you for delaying my response. I was under the impression that I already replied to all the queries, until I received a reminder email.

The original biopsy of your husband (12/14) revealed that there is presence of cancer in apex of prostate gland on the left side and on the right side of the gland cancer involves, lateral, apex, mid and base of the gland.  The Gleason score which indicates how closely the cancer resembles normal gland and predicts behavior of the cancer. Higher the grade more aggressive is the tumor. Your husbands score is 7 (range 6 - 10), which indicates moderate risk and some cells will grow slowly and others at a moderate pace.

The tumor markers, p63 and high molecular weight cytokeratin confirmed presence of cancer.

The MRI: shows cancer in the right side of the gland in same locations as the biopsy. There is no cancer on the left side.
If the cancer has reduced in size  or volume can only be confirmed by comparing with a previous MRI.


I hope this helps.
Wishing your husband good health

Pathology

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Neha Dahiya MD

Expertise

Help patients understand the medical terminology of their lab results and / or tissue biopsy reports.

Experience

I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory in India.

Organizations
Indian association of pathologists and microbiologists.
International Academy of Cytology
International association of Pathologists - Indian division
Indian association of Cytology

Education/Credentials
MD (pathology) MBA

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