Is it possible to have a Gleason score downgraded?

@surftohealth88 I pray for the day Gleason scores are no longer used - they are just as you said - in the eye of the beholder.
And pathologists all focus on different things! Some use depth of stain, others, the pyknosis or distortion of the nucleus, others the shape or pattern…and in the end the result is their ‘impression’…REAL scientific, eh?
Don’t get me wrong, Gleason (like PSA) has been the gold standard for decades, but with all the new tests - Decipher, Artera, etc., we need a more measured, qualitative way to determine just how dangerous a particular strain of PCa cell might be.
One patho arguing with another about seeing ‘more of these’ and ‘less of those’ amounts to a pissing contest with YOU paying the freight…gotta change and get with the times…
Phil

Biopsy 3/4 @5% 2nd opinion at a COE was 3/3. Final pathology after surgery 3/4 @30 % so obviously down graded then upgraded!
My surgeon does not put a lot of stock into decipher scores as decipher is based on what the biopsy hits and not necessarily what is present elsewhere in the prostate. Also decipher scores change as cancer progresses.

It is not uncommon to ask to have your biopsy slides sent to another facility for a second reading. In my case I had them sent to John Hopkins and my insurance paid for the second review. It seems downgrades are not uncommon. Remember possibly 12 to 15 biopsy cores were taken so that is quite a few so seeing a change of reading in a couple is not uncommon especially since a biopsy is a very small measurement to make the decision as to what Gleason it is. One thing to remember even if some of your cores were read as a Gleason 6 or even a Gleason 7, if even just one core is read as a Gleason 8, that is what your Gleason score is for diagnostic purposes with your Doctor and recommended treatment protocols. The highest Gleason score of any of your individual cores, even if it is in just one core becomes your Gleason score. It is not uncommon for an individual biopsy to be read differently by another pathologist. In my case I was hoping for my one Gleason 8 core to be reduced and it was not, although I had two Gleason 7 reduced to a 6. In the end I was still a Gleason 8. Now these are just the biopsies, a snap of your prostate in a very small core biopsy. That is why after a prostatectomy, a review of your entire prostate is done to truly measure your Gleason score. It is just as often a Gleason score will change from a review of the entire prostate to what was seen in a biopsy.

@mikefassino
Decipher is all about statistical analysis of hundreds of thousands of previous patients. It is likely to be accurate, but there will always be the individual’s that were outsiders. Like any statistical readings, often an individual outside reading above or below are dismissed. It will be interesting to see how AI impacts this.

@beachflyer Decipher is based on the most aggressive biopsy core, the same is true for the biopsy gleason score. So, the same caveats would apply. Surgeons are often dismissive about Decipher, I believe because it does not affect treatment from their perspective. Radiologists, on the other hand, rave about Decipher.

@wheel1 I am pretty sure Decipher was constructed using machine learning, a form
of AI.

I don't think it is Decipher that will replace pathology, not even close. But really good image processing, perfected over lots of data, can probably out-grade some of the best pathologist eventually. Maybe not today, but it is coming sometime. Maybe there will be competing algo's doing the grading through image processing, and it will really get very good after awhile. I mean 30 years ago we were doing cell sorter with image processing, but that was easier, very differing cell types looked very differing, so easily grouped and so on. You can enhance image processing with things like florescence since perhaps as the gleason goes up the wavelength the cells fluoresce at will change. So a normal cell is at 500 nm, a gleason 6 at 550 nm, a gleason 7 at 600 nm, gleason 8 cells at 650 nm. So add that to the pattern matching and voila better than pathologist, or really it is a tool pathologists can all use to get better data, not today of course and not to fully replace them.

Decipher can not replace pathology.

Decipher is complementary "tool" that measures number of mutations present in a tissue sample.

The more mutations the more aggressive the cancer is.

There is no reason for urologist to ignore Decipher since it is important to know what is the chance of BCR and also if BCR happens what would be correct path forward - RT alone, RT with ADT or RT with ADT PLUS Apalutamide (or similar). Always insist on getting Decipher on your samples.

Gleason is not always correlated with Decipher score. One can be Gleason 8 and have very low Decipher score !!! For that patient it could mean that RT alone is enough , while for a patient with high Decipher RT should be accompanied with ADT, end so forth.

Thank you all for weighing in. Just sent my slides to John Hopkins for review.
Decipher, .46, Gleason Score GG2 3+4, PSA 2.93, Prostrate 69cc.
My urologist was not advocate to get the Decipher my RO sent it out.
Will post any changes this week.
Obviously hoping for down grade, but realize there is the possibility for an upgrade.

Ray

@ray092271 The reason is the RO uses the Decipher score to decide what if any ADT should be added to a radiation treatment plan. The urologist is going to do a RP regardless of the score and will not use ADT unless/until there is a BCR.