Question on Post Op Pathology Report

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KrisP
Regular Member


Date Joined Mar 2008
Total Posts : 162
   Posted 5/1/2008 4:48 PM (GMT -6)   

Not sure if this has been discussed in any previous thread as I've search but unable to find a definite answer. I've noticed quite a few cases where the Gleason and Stage scores have been upgraded from the original determination after the pathologist has examined the entire prostate when removed. I'm assuming that the latter is more accurate because the pathologist has access to the entire removed prostate.

The question I have is what about the folks that took other treatments where the prostate is not removed. How can it be determine if the Gleason and stage are the same or need to be upgraded if the prostate is intact? Maybe I don't fully understood Gleason and stage but it certainly been bugging me since my scores were upgraded after surgery. All I know is the Gleason score and Stage tell the aggressiveness and stage of the cancer. Does it not matter what these scores are after treatment?
Biopsy done 3/2008
Pathology report: Gleason 6 (3+3), involving left lobe
DRE=15gm with indurated left base and mid prostate
Cores positive: left base medial, left base lateral, left mid medial and left mid lateral (4 of 12)
Clinical stage t2b.
Prostate Carcinorna 185
DaVinci Surgery on 4/21/2008 in Austin by Dr Randy Fagin.
Pathologist report upgraded to a Gleason 7 (3+4)
Clinical stage upgraded also to a T3a
Margin Clear


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/1/2008 5:23 PM (GMT -6)   

I think you're right in assuming that the Gleason and staging are more accurate after the pathology from a removed prostate. The Gleason can go the other way too -- pre-op I was Gleason 4+5=9 and post-op 4+4=8.

It is a grey area and a matter of interpretation whether a group of cancer cells fall into one grade or the next. If you ever look at illustrations of the Gleason grades, it's so hard to judge -- even the pathologists sometimes don't agree on the same samples!

So my non-medical opinion is that the pre-op figures are generally "good enough". Of course it is better to have a whole prostate to test, but before treatment, the doctors have to do the best they can with what they can extract from you :-)


Age 63. Other than cancer, in good health
Left hemi-colectomy April 2006 (colon cancer)
PSA 5.7, Gleason 4+5=9
RRP 7 March 2008, non nerve sparing
Histology showed clear margins and lymph nodes
Two nights in hospital
Catheter and staples out after 7 days
Continent, no pads needed from the get-go
No erections (of course!)
Experimenting with VED and Bimix
 

Post Edited (Piano) : 5/1/2008 4:28:15 PM (GMT-6)


positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 5/1/2008 5:59 PM (GMT -6)   
It is a grey area, but I would have thought that most people would probably give more credence to post op pathology report because they have the whole prostate to look into. At the same time reverse also seem to happen as was for Piano !! So the jury is out. Is it worth getting a second opinion on post op pathology report ? Most of us get 2nd opinion on biopsy results, why not that many on post op reports?

The main thing is that the beast is out and the margins are clear;whether it be an upgrade or downgrade of the scores.
Dx Age 48 Nov 07

PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
Wished had done enough research but was in muddy state of mind
Robotic surgery Jan 08

Found Healing Well Forum Feb 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement

1st post op Psa <.1 (May 08)


njiceman
Regular Member


Date Joined Sep 2007
Total Posts : 28
   Posted 5/1/2008 6:11 PM (GMT -6)   
Kris
If you go to this web sight http://en.wikipedia.org/wiki/Gleason_score
you will see that the scoreing is very judgemental. Of course the rateing on the entire prostate is the best, but you could have ten different clinisions evaluate the same sample and get several different ratings.

Be glad the devil is out and the margins were clear.
Age- 59
Diagnosed July 2007
PSA-4.0 (Free psa 11%)
Biopsy August 2007 - 2 of 4 on Right Side with 20%, Stage T1c
Gleason (3+4)
Cat Scan & Bone Scan both Clean
DaVinci Surgery Nov. 26th RWJUH Cancer Center, New brunswick, NJ
11/27/07  Home & on the road to recovery
12/4/2007 Catheter Out!
Pathology Report:  Gleason 3+3=6
                          Stage   T2c
                          Organ contained Negative Margins
1/1/08  Back to Officiating Wrestling
2/27/08 1st Post Op PSA...<0.1 Undetectable
Still using a pad everyday for minor leaks (using Detrol for bladder spasms)
4/1/08 Trying Levitra every other day  very little response :(


VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 5/1/2008 6:43 PM (GMT -6)   

Hey Krisp,

Hello, my wife does all the writing here on the forum, I just read and learn, so I hope I am doing this right.....

I have noticed that the biopsy gleason predictors and the actual pathology gleason scores are almost always spot on, usually no more than one point off, and I attribute some of that to the time laspe between biopsy and surgery. I think it is only natual to second guess everything when  you are going though the misery of recovery, Lord knows I have had my moments, and it only reinforces how important it is to get all the info you can before you decide on your course of action. You can find out a lot in six weeks, the average waiting time between biopsy and treatment, and you don't want to be on this side wishing you had asked your Doctor about this or that, so I applaud anyone who helps the new guys by sharing their experiences. Has certainly helped me and Cindy.

Kent


Age 51 Kent
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 anpther round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th.
Cindy (the wife!!)
Surgery preformed and doing great. Only took 1 1/2 hours. Will know in two weeks about pathology report. Surgeon feels he he got all cancer and confined to prostate. Both nerves were spared.
Home 4-11 - incision looks completley healed on the outside by 4-25
Cath out 4-22 dripping some
Cancer confined to one side of prostate.
Cialis 5 mg at night to start
Outlook very positive!!


KrisP
Regular Member


Date Joined Mar 2008
Total Posts : 162
   Posted 5/1/2008 7:02 PM (GMT -6)   
Thanks for all the replies but I guess I didn't do a good job in asking my question. So I'll try again.
We know that the post surgery pathologist report is the most accurate. So here is my question - Folks that took other treatment, and still have their prostate intact, cannot really say for sure what their scores are since the only way to detemine this truely is to have the entire prostate out for the pathologist to examine.
Hope I did a better job this time around.
Sorry
Kris


Biopsy done 3/2008
Pathology report: Gleason 6 (3+3), involving left lobe
DRE=15gm with indurated left base and mid prostate
Cores positive: left base medial, left base lateral, left mid medial and left mid lateral (4 of 12)
Clinical stage t2b.
Prostate Carcinorna 185
DaVinci Surgery on 4/21/2008 in Austin by Dr Randy Fagin.
Pathologist report upgraded to a Gleason 7 (3+4)
Clinical stage upgraded also to a T3a
Margin Clear


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/1/2008 7:27 PM (GMT -6)   
Hi Kris,
I agree largely. This is why there are more having surgery than any other primary treatment. Though I will add that this does not necessarily mean better results with surgery over say radiation or in advanced cases hormone therapy. But you will find many of the other techniques won't be offerred if the disease is known to be more advanced. My post operative pathology was predictable because of the high PSA and it was largely different than the clinical pathology. Many doctors would argue that mine was inoperable but I'm glad we removed it. I am also glad I know where I am. I have had the ability to add adjuvant therapies hoping that this does not come back. Still living, hoping...

Stay Positive.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
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