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Regular Member

Date Joined Oct 2009
Total Posts : 314
   Posted 11/16/2009 6:47 PM (GMT -6)   
I'm curious -
Over the past couple of weeks I have talked with four guys I know who, like me, were biopsied elsewhere before electing M. D. Anderson Cancer Center in Houston for treatment.  It may just be a coincidence, but every one of us exerienced the same thing - our Gleason score was higher at MDA than our initial Gleason score on biopsy [3 + 3 became 3 + 4; 3 + 4 became 4 + 3; that sort of thing.]  Exact same slides, just different pathologist.
I know that I can send my slides to a third pathologist for another opinion [actually, in my  case, a fourth opinion: I had a 3 + 3 on biopsy, a 3 + 3 when a second urologist had the slides re-examined, but then a 4 + 3 at MDA].
Given the very subjective nature of Gleason grading, I'm wondering if MDA just happens to have a pathology department that has a tendency to see 4's where others see 3's and so forth.  rolleyes
There might even be an institutional incentive to do so - MDA's survival statistics will look better over time if their reported Gleason scores before treatment are higher.  idea
MDA has a world-class reputation, and I am not arguing here that it doesn't deserve it.  And in the final analysis, the cancer is (hopefully "was") what it is, whatever the numbers put on it by a pathologist.  But I can't help but wonder if anyone else has experienced the same thing at MDA that my friends and I have - or have any other thoughts on the subject?
Thanks in advance.

Post Edited (Zen9) : 11/16/2009 4:52:26 PM (GMT-7)

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 11/16/2009 6:55 PM (GMT -6)   
Hey Zen,

The subjective factor in Gleason grading has always been a concern with me, and I am sure many others here. If one is really a true 6, you would look at your choices in one manner, if it really is a 7, then you look at it a different way. Makes you wonder how many 7s are really 6s, and perhaps being overtreated, and how many 6s are 7s or higher, and being undertreated.

Yours is a good point. I understand the subjective nature diminishes when looking at 4 and 5 cells, their cell structures are pretty far out there.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 11/16/2009 7:00 PM (GMT -6)   
My biopsy was 3+4 7 Post surgery path was 3+3 6.... I must say I like that better. None of mine were at MD Anderson.

Jeff t
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 11/16/2009 7:36 PM (GMT -6)   
Reading slides is subjective, but I remember reading that the Gleason Grading System was designed to get a 90% agreement from different pathologists reading the same slide. Maybe the patholigist at Anderson is one of the 10%. If the difference would affect the treatment option you would choose then I would definately get a 3rd reading from Epstien at Hopkins or Bostwick. If you are going to have surgery anyway whether it is a 6 or a 7 why bother.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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