Prostate Biopsy at Mayo Clinic

I had the exact opposite experience I can guarantee that. Once Dr Epstein left JHU (just as I was sending slides) the biopsy report for me was just a few scant lines with no physician name (probably somebody in training but no apparent supervision since Epstein was gone). This was last year. The Mayo/Rochester one was super professional and very detailed. JHU even mixed my paperwork up, multiple calls resulted in nothing. I felt it was just a money making effort done by somebody unsupervised + untrained and poorly done completely, plus with the paperwork mix up I even call into question their entire practices. Perhaps JHU has picked up since, but to be honest I would never send another thing to them, and I am a JHU graduate.

Dr. Matoso at JH read my slides and spoke to me in depth. Their pathology report will always indicate the total percentage of tumor tissue Ina single core and the separate percentage of grade grp 4, which is what is needed specifically if you have anything but G6. And they include the tissue changes as in cribriform morphology. If a report is lacking these elements, that's an issue.

We have had both type of pathology report experiences at Mayo Clinic in Rochester. My partner is a pathologist (now retired) and after talking with a senior pathologist he knows at Mayo it became evident there is a template or checklist that pathologists use in the case of some biopsies. What this means, depending on the pathologist who reads the slides and then provides the report, is that some biopsy results will report from that template without detailed information. Mayo Clinic in Rochester performs a multitude of prostate biopsies. When we received a pathology report without much information we’ve asked for the slides to be re-read by a senior pathologist and for more detailed information including a description of the gross specimen. The diagnosis did not change. After that second reading we then had additional information including a more detailed description of the actual tissue before the clinical lab staff prepared the slides that provided the assurance to my partner that the lab specimen examined and the diagnosis were both accurate.

Thanks, Helen, for the good info you shared. I had no idea that it was even possible to ask for another reading of a biopsy report! Because I’ve never had one before, I figured what I got, though sparse, was just the way they do all of those reports.

When we wanted a second opinion from Johns Hopkins, we had to fill out a form giving permission in the urology department. The person at the Urology reception desk told us, in error, that “Mayo does not send the slides, they just send things electronically.” We knew from Johns Hopkins that this would not be adequate, so we called our urologist’s secretary and asked her to have pathology send my slides. (Even though the woman at the front desk had gone ahead, without our agreement, and checked every single box on the form!)

Once we got the second-opinion pathology report from Johns Hopkins, we saw that Mayo had not sent many of the slides — including one of the ones that showed cancer!

So we dealt with the pathology department at Mayo again, and had them send the rest of the slides. That turned out to be important, because it was that second batch of slides that came back telling us of “large cribriform morphology” and “perineural invasion.”

My wife used to work at Mayo before she retired, and we have generally had excellent positive experiences there for our healthcare through the years. So I don’t want to paint a negative picture of Mayo Clinic at all.

But I did want to give this story as a cautionary tale to anyone else intersecting with the pathology department at Mayo Rochester.

To repeat: overall I’ve been very happy with my care at Mayo.

Jim G

@jamesharrison Jim, I’ll ask my husband about sending slides since I don’t know about that. It could be different policies at different institutions. I do know that when my pathology results/slides for endometrial cancer were sent from our local pathology practice at our hospital to Mayo in Rochester. I figure it’s worthwhile to ask about policies and then advocate or push back if said policy seems overly restrictive.

Our local orthopedic practice, for instance, will not send out a referral to another institution for a second opinion and they won’t send their images. When I wanted a second opinion from Mayo I had to make the request myself and send the images myself that the orthopedic practice provided on a CD.

It’s good that you are happy overall with your care at Mayo. My husband has had some “glitches” if you want to call them that in working with Mayo urology for prostate health. These have been largely solved with communication with urology. Wouldn’t you know that my husband, the retired pathologist, is a lab guy with a speciality in clinical chemistry and so he questioned the ordering of some lab tests and the subsequent interpretation of those tests. It all got straightened out.

Differences in prostate pathology reports

Here is my experience with Johns Hopkins Pathology Dept in Washington, DC. Two prostate biopsies were performed in March 2023 and recently in April 2024. There were 11 tissue samples taken in each case. I then compared the findings of the two reports. For example, the LEFT ANTERIOR LATERAL (BIOPSY) on 3/2023 was compared with the LEFT ANTERIOR LATERAL (BIOPSY) on 4/2024. On 3/2023 it said "Gleason Score 3+3=6 (Grade Group 1) involving 40% of one (1) core." But on 4/2024 it said "Benign prostatic tissue." The next two biopsy comparisons were also different in other ways. While this was quite disturbing to me, I would explain it this way. A house at 6002 Oak Street is the general target based on the prior MRI image to obtain tissue sample # 5. So, on 3/2023 the urologist takes a tissue sample from the living room area and it goes off to the pathology dept and is reported as Gleason Score 3+3=6. However, on 4/2024 the urologist goes to the same target/house BUT this time obtains Benign tissue from the backyard. One might expect the two samples to be taken from precisely the same spot each time for a comparison due to the medical tech of today. So taking biopsies from the same lesion can produce different results on your path report. Before your biopsy procedure, an MRI scan of the prostate is generally done. The images it produces are then used by the urologist to navigate to the biopsy sites. IMPORTANT: the very best images, as of now, are produced by a Tesla 3 mpMRI (Multiparametric magnetic resonance imaging). It "is a specific MRI test used to detect and evaluate prostate cancer. It requires additional radiologist training and sequences not routinely performed in anatomic imaging." During the prostate biopsy procedure the urologist will then "overlay" the mpMRI images with the Transperineal UltraSound images (TPUS). TPUS is the best and is the safest. The device used on me was called URONAV by Phillips. In summary, I have total confidence in the JH Pathology Dept in Washington, DC.

I might add that Dr. Matoso did the second opinion at JH. And then I spoke with him at length for about an hour on the phone. He was awesome 👍🏼. And he was a URO before he was trained in pathology. Answered all my questions and went into detail on % of grade group 4 and it's importance.