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Biopsy GS variations
I have a question? What is actually my GS diagnosis ? I have varying numbers in my reports.
My biopsy for diagnosis before RP was:
7 cores
3 cores Benign
4 cores GS 5+4=9 (5)
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My RP report biopsy on tumor after RP has this:
Grade Group and Gleason Score
Grade Group
Grade Group 3 (Gleason Score 4+3=7)
Minor Tertiary Pattern 5 (less than 5%): Present
Percentage of Pattern 4 in Gleason score 7: 70%
RP report also has this:
Prostate, radical prostatectomy: Prostatic acinar adenocarcinoma, (Grade group 4, Gleason pattern 4 + 4) forming a
4.5 x 2.2 x 1.7 cm mass involving right and left prostate and extending to the right seminal vesicles. Left posterior apex
margin involved by carcinoma (4 + 4) <1mm and left anterior apex margin (3 + 4), 3 mm. All other margins are negative
for tumor.
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This is definitely a confusing report. It tells you, you are a 4+4 Also a 4+3 and you cannot be both, They can come up with both numbers in different areas, but you would be a 4+4 if there is actually a higher score somewhere in your prostate.
You need to speak to the doctor about this and get this clarified. We can’t really tell you the answer because they are giving you confusing information. Have them go back to the pathologist and find out what they really meant to say.
This could be due to the doctor using voice recognition to write this report, and it was incorrectly Translated. That happened to me on one report that the pathologist had to correct.
If they cannot straighten this out, you can send your slides to get them reviewed by an Expert like Doctor Epstein Who has seen hundreds of thousands of biopsies. He does charge $500 for the biopsy review. You could call him on the phone before doing it and he will talk to you about having it done. He will arrange to get the slides sent to him. He will talk to you after the biopsy report is done and give you detailed information.
Dr. Epstein biopsy
https://advanceduropathology.com
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Hug
2 ReactionsI sent the question to my doctor’s office as the original biopsy before RP was a high score then the biopsy on removed tumor has two scores.
I sent message asking :
I am confused. Is my Gleason score
5+4=9 (5) (biopsy)
Or
4+4 (RP biopsy)
Or
3+4 (RP biopsy)
Your Gleason score is definitely post RP since now they have the whole prostate (the full apple) to look at not bites of the apple from a biopsy. It is not uncommon for it to be downgraded. That being said Jeff is correct your Gleason score is always the highest of your individual biopsy cores. I have never heard post RP different Gleason scores as maybe at that point they typically just give the highest and in your case they described two. It obviously seems reasonable upon looking at the full prostate it would like a biopsy have different areas of Gleason. I would imagine it would be considered Gleason 8, not your original Gleason 9. Take the win, and know even a good part was only a 7.
They just gave more detailed picture of the whole prostate IMHO.
They gave gleason score for left POSTERIOR part and than separately for left ANTERIOR apex and specificaly important due to POSITIVE margins in BOTH those regions.
So, conclusion should be that gleason score for the whole gland is 8.
There are 2 positive margins , one at gleason 8 and one at gleason 7 place on the prostate.
Seminal vasicle involved also.
BUT, there is also pattern 5 pesent in the prostate specimen, so I do not know why was it ignored ?
I would definitely ask for second opinion and clarification.
Overall the I think that bigger problem is presence of positive margins and vesicle involvement than question if gleason is 8 or 9.
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Hug
1 ReactionClearly further treatment may be likely, but don’t get tied up over whether it’s a 7 or 8, it seems no longer a 9, and that number of 9 can be extremely demoralizing so regardless consider an 8 and 7 positive. At this point begin to determine your best steps forward. Maybe you were thinking your glass was half empty but maybe it’s half full. State of mind, outlook , positive attitude all play a role
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Hug
1 ReactionThanks for all your explanation and advice. The moment it was determined that it has extended to right seminal Vesicles but has not metastasized anywhere else in the PSMA PET scan, RP was done immediately and PSA was monitored.
PSA crept up in one year from undetectable to 0.3. PSMA PET scan confirmed recurrence. Went through 20 Photon radiation IMRT as well as on Orgovyx. Waiting for 3 and 6 month PSA and Testosterone tests before requiring another PSMA PET scan. Also will be tested bone density, liver and lipid. Anything else I should be looking at ?
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1 Reaction@wheel1
Actually 8, 9 and 10 are often grouped together in most papers and all represent high risk cancers unless proven otherwise by Decipher score.
@mrunr
Sorry to hear that you had BCR, but unfortunately positive margins and vesicle invasion did put you in high risk for having one : ((.
I am wishing you super successful RT and may you be cancer free in very near future 🍀.
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1 Reaction@mrunr Should do a CBC since Orgovyx can lower hemoglobin/hematocrit to anemic levels. Make sure panels are ordered for liver (CMP) and lipid (probably what is being done, may have also included CBC but you do not know if you do not ask) since they provide more info than single test.
They may be considered that way but don’t all act that way and why most people for their well being should remain optimistic and others should be supportive but then their are many that always do see the glass half full
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