Did you contact the Epstein office to pursue this difference of opinion? There’s probably a very fine line between 3+3 and 3+4 with some slides. Contact their office to find out how they came up with a 3+3 when other places say 3+4. Was there a fine line in some of the slides they saw that they interpreted as 3+3.

Had HoLEP (so far so good), biopsy was 3+4=7, oncologist recommended Decipher-PSAMA-PET/MR Pelvic also both with and without regents and then decide course of action..totally confsued!! Age 67

This is a tough one - Epstein is doyen in his field but 3 other reports place it in 3+4 group ! Everybody can make a mistake so can Epstein. How about you send it to another big center like Hopkins or Mayo ?

When I was diagnosed with 7(3+4), I got a 2nd opinion on the biopsy tissues. I understood fully that a Gleason score is just a pathologist’s educated, expert opinion of what is seen in the tissues under a microscope. A 2nd (& 3rd….) opinion is exactly that as well - just one pathologist’s educated, expert opinion of what is seen in the tissues under a microscope.

Much of the interpretation of images, scans, and slides is often as much an art as it is a science and dependent on the skill and experience of whoever is doing the reading.

In my case, I made a commitment:
> if the 2nd opinion came back a lower 6(3+3), I would still get treated to the higher 7(3+4).
> if the 2nd opinion came back the same 7(3+4), I would get treated to the 7(3+4).
> if the 2nd opinion came back a higher 7(4+3), I would get treated to the higher 7(4+3).

As it turned out, the 2nd opinion came back a higher 7(4+3) so, out of an abundance of caution, that’s what I got treated to.

You’ll have to establish your own criteria for which biopsy interpretation you’ll use for making your treatment decision.

Wishing you the best in your decision.