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Subject:Repeat biopsy strategy for HGPIN

Does anyone have any ideas re Watchful Waiting as it might apply to PIN (prostatic intrepithelial neoplasia). I was diagnosed with it 3 years ago and have had 3 biopsies negative for cancer. The last two removed 13 separate tissue samples each. I am 72 with a PSA of 1.4, a complexed PSA (i.e.,cPSA) of .87 and free PSA 25% PSA has been steady for last 5 years.

My doctor thinks the biopsy hunt for cancer should end unless my PSA (1.4) accelerates and/or future digital exams show abnormality. He'd examine me once a year----a sort of watchful waiting.

PIN, he argues, used to be thought as an inevitable precursor to cancer. But now with the rigorous 13 sample biopsy (twice the usual number of the classic sextant biopsy and a more thorough template), people with PC are usually caught early on and that my risk level for PC is now very low. He points to 2 studies, as yet unpublished, that point to this as an logical procedure or men with PIN who have had the new more thorough biopsies.

Any thoughts would be very much appreciated.


The doctor, due to the relatively new biopsy (13 core samples--Ouch) procedure I've undergone (negative for cancer), feels that PSA testing and DRE need be done only once a year.

Evidently there are 2 separate studies that, independent of each other, have shown a very low risk in cases where such a rigorous sampling has turned up no cancer. (In my case done twice) He also feel that even if cancer were to be found at my age (72) it probably would be clinically unimportant. He goes on to opine that most all men later in life have some cancer and won't die of it. He likens my odds to that similar to some one actually knowing a person who died in an air crash..!! Yikes, I have known 3, all in separate accidents and I, myself, came very close in yet another. Bad analogy. Was Mark Twain correct when he suggested that there are big lies, little lies and statistics?

My PSA has been stable for quite a while (10 years) ranging from .8 to 1.7 and most recently at 1.4. I'm concerned, though, since PSA is not specific per se to cancer.

I like my doctor and basically trust him (as I think you ultimately must), but can you trust medical science? Just think of the women who were encouraged to take estrogen supplements, only to find out 10 years later that it may have caused serious harm.

On the other hand I like the idea of no more biopsies--for the time being, anyway.

I appreciate your views a lot



Posted: 24 Jun 2004 12:35 AM
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Total Messages 63

Subject:Repeat biopsy strategy for HGPIN

Your doctor is doing the correct thing. PIN was thought to be associated with prostate cancer when found on biopsy and was used as an indicator to rebiopsy. More recent studies refute that finding and current practice with regards to the PIN finding is to observe patients unless there is an acceleration in PSA velocity, a significant decline in free PSA, or a change in the DRE. You have been adequately sampled with regards to prostate biopsy and I would concur with the yearly evaluation.

Christopher G. Wood, M. D., FACS

Posted: 24 Jun 2004 12:56 PM
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