Interpreting Prostate Needle Biopsies in Today’s World
Interpreting Prostate Needle Biopsies in Today’s World
Dr. Jonathan Epstein, MD, Advanced Uropathology
Reliable biopsies are critical to selecting the right treatment at all stages of prostate cancer – we’re talking needle tissue, not blood, btw. Get it wrong and you may get too much or too little treatment.
Reading pathology is part art and part science! AnCan Advisory Board Member, Dr. Jonathan Epstein is globally acknowledged to have the best eye in the genitourinary pathology world. AnCan frequently refers men to him for a 2nd opinion. His presentation will include:
Getting the most out of a 2nd Opinion
The relevance of cribriform, intraductal, ductal, & small cells
In our prostate cancer world, getting 2nd opinions is critical. It’s easy to find a medical 2nd opinion, and you can get your pathology reread by the best! But MRIs – that’s been challenging. Now there’s an affordable AI-validated option that’s proven very reliable* –ProstateID
*Sensitiviy and Specificity in the mid-90% range
Founder and Developer, Randall Jones, PhD explains the technology and its uses. Hosted by AnCan Advisory Board Member and prostate cancer peer, Dr. Mike Crosby.
No need to register ahead. Drop in and join us for this webinar.
Hi-Risk/Recurrent/Advanced PrCa Video Chat, Aug 12, 2025
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Novartis, Johnson and Johnson, Myriad Genetics, Telix, Blue Earth Diagnostics and Foundation Medicine
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: You’re not alone if you have lungs-only metastasis. (bn)
Topics Discussed
He’s responding to ADT, but we keep wondering about the “neuroendocrine hyperplasia” found in his lung; salvage radiation is recommended, but mom’s bad radiation experience leaves him fearful; even with cribriform, Gleason 4+3 puts him in the low/intermediate group; the word is “debulking” for giving prostate radiation after de novo metastasis; low-PSA-producer sees a doubling in 3 months, but it’s from 0.016 to 0.032 — is that worrisome?; with new oligomets, he wonders if he should get chemo now and be done with it; minimal cancer found in his blood test and negative PSMA — he’s celebrating; abi patient gets facial swelling — is the physician assistant handling it properly, and why wasn’t he warned against stopping prednisone too quickly?; swimming through bureaucratic murk to see a radonc.
Chat Log
Ancan – Bill · 6:36 PM
Jim, Bravo Zulu for the referral award tonight!
AnCan – rick · 6:43 PM
I think Prostox may now be available.
Steve Roux, North Michigan · 6:45 PM
PROSTOX, a genetic test designed to help prostate cancer patients minimize the risk of radiation toxicity, is available to patients in the USA, with the exception of New York State residents.
Steve Roux, North Michigan · 6:49 PM
A list of Early Access Providers who offer PROSTOX testing can be found on the MiraKind website. These providers include institutions like the Mayo Clinic, UCLA, and UCSF Radiation Oncology.
Jim Marshall, Veteran, Alexandria, VA · 6:56 PM
Orgovyx is the pill. versus Lupron
AnCan – rick · 7:00 PM
In no circumstances a 6-mo DEPOT.
Jon McPhe · 7:03 PM
Anyone got a short version of why Orgovyx and not Lupron? I ,ay have to make a choice tomorrow.
Steve Roux, North Michigan · 7:04 PM
I did not tolerate Lupron well at all.
Steve Roux, North Michigan · 7:05 PM
I saw a GU Oncologist who put me on Orgovyx which is a pill and easy to take. Very much less side effects.
Julian – Houston · 7:05 PM
I was on Lupron then got switched over to Orgovyx and Nubeqa.
Steve Roux, North Michigan · 7:07 PM
Gerry / Cynthia – if you are on medicare, the new max out-of-pocket for drugs is reduced now to only 2,500.00 per year. That makes Orgovyx very affordable.
RJ Smith (Seattle) · 7:07 PM
Orgovyx you can stop taking the daily pills, and testosterone will come back much quicker. Multi-month Lupron will keep on going, and doesn’t stop completely on the last day of the month.
AnCan – rick · 7:12 PM
We call that debulking the primary
Jeff Marchi – San Francisco · 7:29 PM
I have been on Lupron for 7 years and Orgovyx for 2 years. After 5 months of Orgovyx the side effects are identical to Lupron
Jeff Marchi – San Francisco · 7:31 PM
Some people don’t produce PSMA, so the scan can’t find anything.
Jeff Marchi – San Francisco · 7:46 PM
First 5 months hot flashes stopped, since then as bad as Lupron 10+ a day most days
Steve Roux, North Michigan · 7:50 PM
https://www.drugs.com/compare/lupron-depot-vs-orgovyx
Steve Roux, North Michigan · 8:04 PM
Thank you to everyone especially you wonderful moderators! Time for my Orgovyx and a bowl of ice cream. Good night all!
Hi-Risk/Recurrent/Advanced PrCa Video Chat, Aug 4, 2025
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Novartis, Johnson and Johnson, Myriad Genetics, Telix, Blue Earth Diagnostics and Foundation Medicine
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Join our other free and drop in groups:
Men (Only) Speaking Freely…1st & 3rd Thursdays @ 8.00 pm Eastern https://ancan.org/men-speaking-freely/
Veterans Healthcare Navigation… 1st & 3rd Tuesdays @ 8.00 pm Eastern Schmier Room https://ancan.org/veterans/
Veterans Speaking freely… 4th Tuesday @ @ 8.00 pm Eastern Schmier Room https://ancan.org/veterans/
Editor’s Pick: Estradiol expert peers Schellhammer and Wassersug discuss ADT and use (rd)
Topics Discussed
ADT side effects and estradiol discussion; restarting monotherapy darolutamide; CT scans carry little secondary cancer risk; cancer is an aggressive variant that can’t be identified; lower back pain; starting ADT + RT for BCR; Ph. 3 AMG509 trial – xaluritamig STEAP T-cell engager; zoledronic acid (Zometa et al) vs denosumab (Xgeva et al); chemo side effects – overdosing steroids?; IDC-P (intraductal) Gent needs new doc; dialiing back IDC-P outlook a tad Chat Log
Chat Log
Scott Romsos – Ely, NV sent: 5:14 PM
It is all good Mr Nathanson, no worries.
RJ Smith (Seattle)sent: 5:18 PM
Hey Steve–so far, so good. Starting IMRT on Thursday (got my gold markers and then tatoos, so good to go). Dr. Meier is awesome, BTW. He isn’t doing my IMRT, but Dr Spiegel in Issaquah seems pretty good as well where that starts on Thurs, and then SBRT for “boost” as well as for rib met after that…. Also, when I got markers put in, they checked PSA, which is now down to 1.02 with the ADT, so definitely feeling I’m on the right path now.
Jerry Grimes, Brighton, MI sent: 5:23 PM
My bone density actually recovered to a normal range after I went on estradiol. I was on the verge of osteoporosis.
Correction, sorry. I only started pet-PSA scans once my psa started to rise…….one year after drug holiday. Then I was was doing scans every 3 months watching for Mets.
Richard Wassersug (Vancouver) sent: 6:03 PM
Sorry, got to go. richard.wassersug@ubc.ca
Frank Ciambra sent: 6:04 PM
goodnight sorry
Julian – Houston sent: 6:22 PM
goodnight all
rd sent: 6:24 PM
Hi Folks…. tech issues and VSS obligations.
Ancan – Bill sent: 6:24 PM
Nice to see you again RD.
rd sent: 6:36 PM
Mark Finn GRHS tried for AMG509
dan, alexandria sent: 6:48 PM
Is there a time limit if you are on Reclast?
John A sent: 6:49 PM
same drug, Dan, zoledronic acid
AnCan – rd sent: 6:50 PM
Probably the same 5 years
Jack sent: 6:59 PM
That relieves me. Thanks David!
AnCan – rd sent: 7:08 PM
Thomas – Sokolova is giving you the run around. If me, I’d iinsist on denosumab in an appropriate dose.
Thomas M sent: 7:22 PM
The zoledronic acid vs denosumab discussion was right on point for me. Thanks for everyone’s input.
David Muslin sent: 7:25 PM
I have to go. Thanks all
George (Chicago) sent: 7:26 PM
Thank you, gentlemen.
AnCan – rd sent: 7:08 PM Thomas – Sokolova is giving you the run around. If me, I’d iinsist on denosumab in an appropriate dose.
Thomas M sent: 7:22 PM The zoledronic acid vs denosumab discussion was right on point for me. Thanks for everyone’s input.
David Muslin sent: 7:25 PM I have to go. Thanks all
George (Chicago) sent: 7:26 PM Thank you, gentlemen.
Hi-Risk/Recurrent/Advanced PrCa Video Chat, July 21, 2025
MARKET RESEARCH STUDIES
AnCan has two new market research opportunities for you and your Care Partners with Pinpoint Patient Recruiting to earn up to $425.
Study #1
• Non-white Men &/or Carers – both can apply but with separate applications • Must be US based • Men confirmed hormone sensitive with or without mets OR castrate resistant • Active treatment is NOT required – you can be on a drug holiday
Study #2 – recruiting for survey in September • Men &/or Carers – both can apply but with separate applications • Must be US based • Men confirmed hormone sensitive with or without mets OR castrate resistant • Active treatment is NOT required – you can be on a drug holiday
$125 for a 60-minute virtual online interview with another $50 for providing evidence from your medical records of your confirmed diagnosis – screenshots suffice. If you opt in for a second interview, another $125 is available. Your Carers also have the opportunity to earn $125 for a 60 minute interview.
Please visit pinpointpatientrecruiting.com/pc-interview-ancan2025 or contact Brittany Weathersbee at brittany@pinpointpatientrecruiting.com. If you’ve already been contacted directly by Pinpoint from a prior study and accepted, please let us know at rd@ancan.org.
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Novartis, Johnson and Johnson, Myriad Genetics, Telix, Blue Earth Diagnostics and Foundation Medicine
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Join our other free and drop in groups:
Men (Only) Speaking Freely…1st & 3rd Thursdays @ 8.00 pm Eastern https://ancan.org/men-speaking-freely/
Veterans Healthcare Navigation… 1st & 3rd Tuesdays @ 8.00 pm Eastern Schmier Room https://ancan.org/veterans/
Veterans Speaking freely… 4th Tuesday @ @ 8.00 pm Eastern Schmier Room https://ancan.org/veterans/
Editor’s Pick: Pain meds should not be a pain! (rd)
Topics Discussed
Fatigue persists despite testosterone increasing and normal cortisol levels; advanced cancer spreads including to liver; using pain meds; identify the cancer before talking treatment and trials; Chuck Ryan gets NJ gold star for holding Gent off treatment; heart issues indicate apalutamide and more cardio follow up; 2x Pluvicto drives PSA down from 0.6 to 0.2 – consider holding treatments back; recurrence 3 mos post salvage RT requires GU MO’s opinion; Newwbie – triplet therapy brings PSA from 4900 to 6 – but GU MO required as QB.
Chia seeds are a complete protein Complete proteins are those that contain all nine essential amino acids. Essential amino acids are those that our bodies cannot create and must be obtained through food. These include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.
John A sent: 5:36 PM
nuts and seeds also for protein
gary peters sent: 5:55 PM
The FDA approved (1/25) a new non-opioid pain medication called suzetrigine, marketed as Journavx. This medication is designed to treat moderate-to-severe acute pain in adults by targeting pain signals in the peripheral nervous system, rather than acting on the brain like opioids.
kang sent: 5:55 PM
Lorigerlimab MacroGenics
Len Sierra sent: 5:57 PM
Lorigerlimab is an investigational, bispecific antibody targeting PD-1 and CTLA-4, designed to enhance immune checkpoint blockade in the tumor microenvironment.
Ben Nathanson sent: 5:59 PM
Gary, it’s approved for specific pain that may not be applicable to cancer patients: short-term moderate-to-severe acute pain (trauma or post-op) only —not chronic pain. But it’s an interesting new approach that’s likely to get plenty of company. The benefit is that you get pain relief plus alertness.
Mike sent: 6:02 PM
psa for years between 6-10, prostate biopsy 1.5 years ago negative, just received ExoDx urine test result =53. Any suggestions? Urologist recommends 25 core biopsy. Thanks
