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FISH Test on urine specimen?
Back on 11/30/07 I had my third TURBT plus Mitomycin-C treatment and have since experienced a good deal of moderate hematuria and some clots & tissue sloughing at times (the latter is likely due to a bit of prostate resect to clear an obstruction near a ureter so the doc could get at some tumors there). The doc postponed startup of Mitomycin-C treatments till the inflammation subsides. I went in a couple of weeks ago for a cysto and he said he wanted to do a urine cytology, but then they neglected to send the specimen off. I went in today and left a urine specimen at their request and his nurse told me they are sending it off for a “FISH” test which will take about 10 days or more to get results. I’m due for another cysto on 2/29, after which they will likely commence Mitomycin-C treatments.
Anyone have any experience/advice to pass along on this FISH urine test?
Thanks!
David Doyle
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27 Replies
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Nancy,
I hope your cysto on Monday is clear. BCG is the “gold standard” and a lot of docs want to jump to cystectomy when BCG doesn’t work. But of course there are other treatments such as Mitomycin that are available.David
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david,
I am sorry the BCG wasn’t the medicine for you. I am hoping it works forme – so far I had 6 wks clear cysto – next on on Monday – if all clear 3 wks of BCG – I guess I have to keep hoping it will help. My Dr did say if I had any return I would have to consider having a cystectomy. One of my 2nd (3rd?) Opinions from the Cancer hospital near me, said there are other treatments – however, I have heard BCG is the best shot. It sounds like you ave a good plan with MD Anderson. We are our best advocate for our health – Education and Follow-Thru!
Good Luck!
Nancy S
Nancy S
Ta CIS
dx Ta 11/06
dx Ta CIS 10/07
No I didn’t. The inflammation from my 6 treatments was so severe that the doc did not feel additional treatments could be tolerated. I had “bullous edema” in the bladder (red puffy bleeding blisters).
David,
I read that you had 6 wks of BCG – did you have BCG maintenance also?Nancy S
Nancy S
Ta CIS
dx Ta 11/06
dx Ta CIS 10/07
[quote author=ddoyle link=topic=1816.msg14286#msg14286 date=1204747747]
Warren,… do you think cystectomy is warranted in my situation (recurrences of TA papillar and CIS, failed BCG, but all non-invasive so far)?
[/quote]Dear David,
I don’t feel qualified to give you that opinion. I think your doctor is concerned that if you have many recurrences, you may become one of those who has a worse outcome by delaying cystectomy. But that’s why you need a qualified second opinion – so that you’re not pushed into something, and yet do what’s best to keep you among us for a long time.
BTW, how about an 8 week course of Mitomycin C if the BCG hasn’t worked? I’s not better than BCG, but it’s different, and it appears to have worked for me.
-Warren
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant 5/2014
Pediatrician
Warren,
I respect your opinion: do you think cystectomy is warranted in my situation (recurrences of TA papillar and CIS, failed BCG, but all non-invasive so far)?
I am going to get a referral to M.D. Anderson if possible for a second opinion. I was a patient there about 11 years ago when I had a squamous cell carcinoma removed from under my tongue (no recurrences).
Thanks,
David
[quote author=ddoyle link=topic=1816.msg14274#msg14274 date=1204728573]
If the biopsy shows recurrence of ANY type of blc, I think he’s going to recommend cystectomy and I will be forced to seek a second opinion and perhaps other options.
[/quote]Hey David,
Why be forced to get a second opinion? Why not plan on it right now. That way whatever decision you make you can be comfortable and know you’ve explored your options.
-Warren
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant 5/2014
Pediatrician
Nancy, Ross, Julie, Susan and everyone:
I appreciate your responses and good thoughts. What I am mainly concerned with at this point is my doctor’s apparent intent to recommend a cystectomy based on repeated recurrences of papillary and CIS — even though all have been non-invasive thus far. He stated that the chances of progression or upstaging are too great to risk waiting, but that does not correspond with the information I have been reading on this forum over the past year. I was under the impression that superficial, non-invasive bladder cancer only progresses to invasive in five percent or fewer instances. If the biopsy shows recurrence of ANY type of blc, I think he’s going to recommend cystectomy and I will be forced to seek a second opinion and perhaps other options.
I would certainly welcome any and all input on this matter. Thanks again.David
David,
Sorry to hear about your results and scheduled TURBT. I hope the results of the TURBT and any subsequent biopsies come back in your favor.
Ross
Ross M
TaG1 March 06
Recurrence Jan 07
BCG Maintenance after 6 week treatment
David
We have both had very up and down highways to travel. At least you are staying on top of everything and I know you will decide on what is best for you. Second opinions are great as long as they are done in a timely manner, but I know you already know that. I did have slides sent to John Hopkins and they were very quick. Always an option.
Try to think positive thoughts,
Nancy S
Nancy S
Ta CIS
dx Ta 11/06
dx Ta CIS 10/07
Nancy,
So nice of you to think of me. I just this minute got home from having the cysto. My doc starting in talking about how upsetting it was to him that the FISH test was positive. I queried him about false positives from FISH but he obviously did not agree that that was likely.
He did the cysto and at first said he saw some papillary tumors and maybe some CIS. Then he took a second look and wasn’t so sure, but said he wanted to do another biopsy so I had to schedule a TURB for 3/28. Not exactly what I wanted but then again no big surprise. This will be my 4th TURB since 4/13/07. Good news was that the inflammation from the last TURBT on 11/30 was about gone.
He also wants to do a biopsy on the prostate area where he resected some tissue back on 11/30. Not looking forward to that.
What bothered me most was he is again talking about the possibility of a cystectomy. His words were, “If we find more CIS or even papillary, you and I are going to have a heart to heart talk about bladder removal.” I argued that up till now everything has been non-invasive but he responded that with my blc and CIS recurring so frequently that our window of opportunity could be small. Not all all what I wanted to hear. If that happens I will definitely seek a second opinion.
In closing I hope your cysto goes much better and that they find nothing at all. Please don’t let my comments worry you — each case is totally unique. I’ll be thinking of you on Monday — please let us know your results asap.
David
David,
How did your Cysto go? I am thinking of you. I have one next Mon. I get knots in my stomach thinking of the outcome.Nany S
Nancy S
Ta CIS
dx Ta 11/06
dx Ta CIS 10/07
David,
I also had a positive FISH last summer (bladder wash). I went through the biopsies of the upper tract and prostate to rule out cancer somewhere else (all negative). What I’ve read about FISH is that it can also be an early indicator of recurrence. However, my last FISH (voided sample) came back negative with a negative cysto. I don’t know what to make of it except for peace of mind it might be worthwhile to look at prostate and upper tract if you get a positive result with a negative cysto.
Ross
Ross M
TaG1 March 06
Recurrence Jan 07
BCG Maintenance after 6 week treatment
The only thing I can think of that should have been done earlier was to scope the upper tract and take biopsies. That was not done until Dick got a new urologist when we moved to Tucson. My understanding is his first urologist followed protocol by doing the IVP’s and the retrograde pyelograms. I hated to be the negative voice re FISH but I think it is more sensitive to
high grade cancer like CIS than low grade papillary TCC. It is important to use both the FISH and the urine cytology. There is another test but I can’t remember the name of it.Dick is holding his own right now. He has a cysto scheduled for next month. They are looking at a new treatment for his MDS which might cure it but first it will make him miserable. Isn’t that the way of cancer medication?
Volunteer Coordinator
ABLSC
Julie,
That’s interesting — and a bit frightening — I’ve had multiple recurrences of TA & CIS in the “Trigone” bladder neck area so there could be something going on in the upper tract. I’ve had a tremendous lot of inflammation since my BCG treatments last spring and continuing on through several TURBT’s since then. I’ll mention this to my URO doc when I go in next Tuesday for my cysto. Thanks for the info. How is your husband doing?
David
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