Gleason Grade Downgrade

I have had more than a few biopsy re-read of pathology slides. Every single time they get differing Gleason scores. It is super common. Lately these bigger centers get all your pathology slides from where-ever you have been, and re-read before you show up. I never get the same reads almost ever on any re-reads. Maybe other people get same reads, but every places differs on mine. It could be some people's cell are altered by things like BPH changing the appearance a bit, like mine would be, just speculation but one possibility.

It is something I heard from a very good prostate information group. YouTube has it. Please check them out!! PCRI Google it ! Highly recognized doctors, urologist, oncologist all about the prostate!!

I had my biopsy done at a Cancer center of excellence (4+3) and sent the slides to Univ of Penn for 2nd opinion, Chief of pathology read them and concurred with the results. Nothing changed.

Do you mean a downgrade at pathology? That happened to me. From 4+4 to 3+4.
I know of at least two studies that found that up or downgrades are fairly common, about 30-40%. For 3+3 and 3+4 upgrades are mire common, for 4+4 and higher, downgrades are.
The reason is that in statistical terms a 12-14 core biopsy is an underpowered sample. Moreover, at biopsy, the highest core determines your overall Gleason score (I assume in order to err on the safe side), whereas the pathology is based on the entire specimen.

Yes it happened to me. I had my biopsy results read at two COEs. One COE said 3+3, the other COE said 3+4.

The way the scoring system works is that if 95% gets the same classification both scores are the same. So, only 2-6% needs to be reclassified to a 4 to make a 3+3 a 3+4 or to a 3 to make it a 4+4 a 4+3 (or upgraded to a 5 to make it a 4+5). More unusual for a 4+4 to go to a 3+4 since that means close to 50% of the sample was downgraded from the previous classification but as noted by topf it does happen.

This is one of the reasons people get a second opinion of their biopsy. I have heard of more than one case where the biopsy Gleason score was reduced. Some people that sent their biopsies for a second opinion to doctor Epstein found this to be a real surprise .

It happens both ways !

Reading GS is the same as reading X-ray or MRI - it is "in the eye of the beholder". It is not exact science like measuring glucose levels or counting blood cells, a lot is left for interpretation and results depend heavily on experience and expertise of the "reader". That said, even 2 experts might disagree about samples that are "borderline" and even experts can make a mistake.