prostate cancer wrong diagnosis? suspicious for but not diagnostic of…what?

Ability will never catch up with the demand for it. - Confucius

A story about a missed prostate cancer diagnosis.

Suspicious for but not diagnostic of prostate cancer.

I’ve told patients for years that the diagnosis of prostate cancer is an easy one to make for the pathologist. It is probably the most common biopsy they get on a day to day basis. I refer to it as a “bread and butter” diagnosis. The inference is that it is not a uncommon diagnosis and it is something all pathologists see often. I have been asked to send off the slides of a prostate biopsy that was read out as positive on many occasions. I have never had one over turned or the diagnosis changed. In addition to prostate cancer being something that the community pathologist sees often, there are now stains available to confirm the diagnosis in difficult cases.
Prostate cancer is an infiltrative cancer, so the pathologist makes the diagnosis more on the pattern of the prostate cancer glands than on the specific nature of the cells. The pathologist where I trained in Augusta, Georgia had a particular interest in prostate cancer. He would describe the prostate cancer as tiny circles emanating from areas of normal prostate glands. He would make little circles with his fingers and then move them all about the screen projecting the microscopic finding  of  prostate cancer.
PIN or Prostatic intra-nuclear neoplasm is when the cell of the prostate is abnormal but the cells are in the normal pattern. These patients are at increased risk for developing prostate cancer and are usually followed more closely than the average patient.
Suspicious for but not diagnostic of prostate cancer type glands are in a pattern that mimic prostate cancer. This where the stains come in and are utilized to confirm the diagnosis. I suppose in the case of this article, this was not done. Now here’s the thing. The author of this article  is still at increased risk of developing prostate cancer and should be closely monitored and even re-biopsied. Remember this about a prostate biopsy, it usually is twelve cores and that only samples a small percentage of the gland. So if your prostate biopsy shows “suspicious” and your repeat  biopsy is completely negative,  you still have the suspicious cells. This happens as a result of “low volume” disease. This can get confusing.  For this patient the change is diagnosis is a good thing, but he is not off the  hook for future  issues. He’ll need biopsies in the future. For the most part, we know that does not have large volume ,  high Gleason’s prostate cancer, and that’s a good thing.
I wondered about my biopsy being “suspicious” and not really being cancer and requested additional stains…they found more cancer. I was surprised however that our pathologists gave me the diagnosis initially without having done the stains. So what is the upshot of all this… make sure that stains were done on your specimen and that a second opinion never hurts anything.
Also, I felt that the author was very fair in his assessment of his situation and about what had happened.  How he reacted, I feel, was unusual for what I see on the internet. It reminds  me of  thinking you have lost something valuable and then find out that a friend or family member hid it as a joke and then gave it to you.  You are more happy at finding the item, than angry  about the prank. This must be  how  this fellow felt.

One Reply to “prostate cancer wrong diagnosis? suspicious for but not diagnostic of…what?”

  1. PSA normal 2006. skipped 3 years. PSA 5.5 Waited another year PSA 8.0 Scheduled for biopsy next week.
    DAD diagnosed age 72 died within one year advanced bone cancer from prostate cancer. I am 58 now. If biopsy is true positive now, what would you do next. Total bone scan, lympth node biopsy, or just remove the prostate and forget about all the other testing. If it has spread you can not cure it at that point. Why treat it? Let nature take its course. I should add that I have often considered this as passive suicide. let it go then do not treat, but then I would use surgery if that would work. I am on the fence. Any help from others that have had similar thoughts?


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