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Cystology and FISH before Cystoscopy?

3 years 9 months ago - 3 years 9 months ago #49523 by jim28
Since I last posted, I have had a CT Scan Stone Study, Cytology and FISH test. The CT scan showed no kidney or bladder stones but did show perivesicular inflammatory changes in fat adjacent to and surrounding my bladder diverticulum. Cytology was negative for malignancy with numerous acute inflammatory cells, rare benign squamos cells and degenenerated urothelial cells. FISH was negative with zero cells showing aneuploidy.

So, based on this, a few questions:

1. Any comments on what they found and how much out of the woods am I?

2. Should cystoscopy be the next step, or based on the negative Cytology and FISH, can cystoscopy be put off while they look for other causes for the hematuria such as prostatitis or an undetected UTI?

3. If I have a cystoscopy, do they usually do a rigid or a flexible in cases like mine?

Thanks for any help.

Jim

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3 years 9 months ago - 3 years 9 months ago #49416 by Alan
Most of us regular readers encourage 2nd opinions. Your case could get complicated which probably makes that even more viable for a 2nd. You definitely want a group or teaching hospital that all they do is bladder cancer as so many add or do mostly prostatic cancer. Sloan Kettering in NYC is often mentioned by posters. Beyond that, I am not a good source living in Texas-to where I'd use MD Anderson.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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3 years 9 months ago - 3 years 9 months ago #49415 by jim28
Thank you Alan for your warm welcome, and calming and knowledgeable words.

I will discuss with my urologist a CT scan. Another possibility for the hematuria is bladder stones, and a CT scan would also be helpful there.

Since antibiotics has always seemed to stop the hematuria in the past, my hunch is that the bleeding this time is being caused by a sub-clinical infection since my recent urine cultures are negative but leucocytes and nitrites are positive.

Regardless,I will probably go ahead with the Cytology right away, but likely hold off on the FISH for now, based on the issue of false positives and the fact that I have a number of other issues that could be causing blood in the urine.

I'm in the NYC area. Do you know, or is there a thread here, with the names of bladder specialists/urologists I might consult with if needed?

Jim

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3 years 9 months ago - 3 years 9 months ago #49414 by Alan
Jim, welcome and we are sorry you have a reason to be here. Let's hope whatever it is, is treatable and not cancer. Based on your history of "minor" problems you have a good probability of it not being cancer in my view-understanding none of us are doctors. Cytology and FISH I believe can also catch bad cells through the entire urinary tract, so the kidneys could have some possibility of something else involved thus those tests. With hematuria you still want to find a cause. I am surprised a CT Scan hasn't been suggested to view the entire genito/urinary tract. Sometimes hematuria has no known cause so that is even a possibility. I am up for my annual cystoscope next week with cytology and it makes no difference to me which order they go in. My URO doesn't believe in the FISH-he says there are too many false positives understanding cytology can yield false positives also.

Hope that helps some.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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3 years 9 months ago - 3 years 9 months ago #49413 by jim28
Hello, First time poster.

Due to blood in urine, my urologist wants to do a Cytology and FISH test, but didn't mention anything about a Cystoscopy.

From what I've read, both these tests are usually done after a Cystoscopy, not prior. (I did have a Cystoscopy 6 years ago with a different doctor and there were no signs of bladder cancer)

My concern is the potential for a false positive that may result in further unnecessary testing, unnecessary surveillance and stress.

I have a history of BPH, UTI's, prostatitis, and a large bladder diverticulum, all which could cause the hematuria.

Thanks for any help in the matter.

Jim

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