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My Pathology Post RALP - originally PSA 135
Prostate Cancer | Last Active: 2 days ago | Replies (7)Comment receiving replies
@heavyphil
After surgery, they are able to look at the whole prostate. Dr. Epstein said, in The latest PCRI conference, 30% of the cases have a change in Gleason score 50-50 up or down.
You are correct for sure, About the fact that what you do can’t change the Gleason score. It doesn’t go down as a result of any drugs. The changes are due to being able to see more of the prostate and in some cases, I suspect, are due to getting a better pathologist. It was mentioned during the conference that you should check the expertise of the pathologist that looked at your after surgery prostate. Was that doctor a specialist in prostate cancer or were they a specialist in breasts or other cancer analysis?. That can make a big difference in what the results show.
Replies to "@heavyphil After surgery, they are able to look at the whole prostate. Dr. Epstein said, in..."
@jeffmarc yes, the pathologist really needs to be an expert in the nuances of PCa.
In my post, I was thinking along the lines of finasteride, which erroneously was thought to cause advanced cases of PCa; but it turned out that the drug shrunk the prostate, thereby allowing a better, more focused look at what was happening, so higher Gleason scores were registered.
So in Mark’s particular case, I found it odd that the Gleason score was downgraded in a gland that was subjected to 10 weeks of ADT/lutamide therapy, since not only can you not change the Gleason, the score might actually increase!
Happily for Mark, they did get a better pathologist who probably read surgical biopsies routinely. Best,
Phil
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@jeffmarc wrote "Yes, you could get adjunct radiation instead of waiting for salvage radiation"
For the benefit of others who might want to research further, the term in question is "adjuvant" radiation, not "adjunct". The distinction between adjuvant and salvage RT is primarily that adjuvant is preemptive whereas salvage waits for evidence of BCR, typically in the form of detectable and rising PSA.