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What Does Biopsy Report For Bladder Cancer Indicate?

Posted on Mon, 1 Dec 2014

Question: This question is for a Urologist. I had surgery to extract a small bladder cancer with CIS's. Subsequent biopsies showed the bladder was free of cancer (for now). I then took BCG. Subsequent biopsies also showed the bladder free of cancer for now, but there was a polyp in the urethra, and it turned out to be the urethelial cancer of the bladder, grade 3, "Papillary". Pathologists can't agree on whether it is stage 0 (sub "ti") or stage 1. Question is -- IF the cancer is stage 0, and is in the prostate, would a "roto-rooter" of the prostate followed by another dose of BCG eliminate the prostate? This is what my doctor is contemplating.

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
You need detail evaluation.

Detailed Answer:
helo
Thanks for your query based on the facts that you have posted I would like to summarize it like this
You had grade one Transitional Cell carcinoma of the bladder which was cured by resection followed by BCG and got cured

Now you have been detected to have papillary carcinoma in the vicinity of bladder neck, or prostatic part of the urethra.

I shall be happy if you can post me few more details to make comments on your problem
1) What is your recent PSA levels?
2)Have you done CT scan or MRI of the abdomen and pelvis ?
3)Has your Urologist carried out Digital Rectal Examination and noticed any hard palpable nodule in prostate.?
4)What is the Biopsy report of existing urethral tumor?

In view of known pathology of the bladder cancer it is likely to be recurrence of bladder cancer and unlikely to be Prostate cancer .It is to be proved and confirmed by multi core Ultrasound guided Prostate Biopsy before taking decision of any modality to treat as Prostate Cancer.

Hope I have answered your query Please feel free to ask if you have more questions.
shall be happy to address the same.

Thanks and Regards
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

1) What is your recent PSA levels?

Answer: 0.6

2)Have you done CT scan or MRI of the abdomen and pelvis ?

Answer: Yes, no lymph node involvement at all was seen

3)Has your Urologist carried out Digital Rectal Examination and noticed any hard palpable nodule in prostate.?

Answer: Yes. No tumor to the touch.

4)What is the Biopsy report of existing urethral tumor?

Answer: High Grade Urothelial Carcinoma. Five 1HC stains are performed for KC7, CK20, GATA3, PSA, and PAP. Tumore cells are positie for CK7, CK29, and GATA3, and negative for PSA and PAP. Bladder biopsies were negative for malignancy after surgery. This High Grade Urothelial Carcinoma was found in the urethra after BCG therapy.

By the way, my semen is bloody.

One doctor says I must take everything out, bladder, prostate, and part of the urethra. Second opinion says do BCG again with a fulguration into the prostatic urethra, also called a "roto-rooter".

My main question is (and I restate): Does this fulguration elminate my prostate completely?

Second question -- can this cancer spread through the blood without lymph node involvement?

Thank you.

Answered by Dr. Dr. P. T. Patil (6 hours later)

Brief Answer:
Fulguration will not remove Prostate copletely.

Detailed Answer:
Hello
Thanks for detail answers.

Fulguration will not eliminate your prostate completely.

Ideally you require removal of Bladder,Prostate (Total Cysto Prostatectomy.) with Reservoir either using Ileal Conduit or Indiana pouch.

Cancer can spread to lymph nodes through lymphatic system and to distant organs like liver,kidney lungs or brain through blood.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

Thank you for your complete answer, Dr. XXXXXXX

I've one more question -- can this cancer IF it is in stage O(ti), and NOT Stage 1, spread through the blood to distant organs like the brain, with NO lymph node involvement?

This is my second and last allowed follow-up question. Thank you.

Answered by Dr. Dr. P. T. Patil (51 minutes later)

Brief Answer:
It will spread if left untreated.

Detailed Answer:
Hello
Thanks for follow up.If left untreated it will spread through blood route to distant organs .

Thanks with regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar