Revised biopsy report--strange?

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compiler
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Date Joined Nov 2009
Total Posts : 7204
   Posted 12/23/2009 12:31 PM (GMT -6)   
I had a biopsy at Umich. I got the report (Gleason 4+3; 5%-30%, 5/12 cores positive).
 
The slides were then sent to Ford Hospital (Dr. Menon's team). Their reading was much better.
(Gleason 3+4, 5%-20%, 5/12 cores positive).
 
Isn't that a bit unusual to have such a difference, or is that typical? I might add that the Umich 4+3 was split 60%-40%, so I guess it was somewhat close. Obviously there is an art to all of this. One would think that a computer could analyze the slides and come up with a definitive report.
 
(But, I'm not complaining!).
 
But, is it unusual? Have any of you folks had two different readings? I realize the post-op pathology report can be different since they then have the whole gland to analyze, but here we have two experts looking at the same biopsied tissues and getting different results!
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/23/2009 12:42 PM (GMT -6)   
Mel...don't know if you have had the chance to look at what a grade 3 cell or what a grade 4 cell looks like, but I will tell you this...even to the untrained eye there is a difference. My guess is that you could have a dozen pathologists look at the slides and quite possible have a split to what they agree upon. Basically, I have heard this is quite common when slides are reread. They sometimes go up and sometimes down. I think it has to do with the individual pathologist reading the sample. Most pathologists would rather error on the high side than to take a chance with a gray area.

Just adds more complexity to this disease doesn't it.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 12/23/2009 12:44 PM (GMT -6)   
There is good reason to have those pathologies checked twice and I recommend it to all the newly diagnosed. I have seen discrepancy between pathologists. That stated, I have only seen on rare occasion that a 2nd opinion on a pathology would actually change whether a prostate cancer be treated any differently. Whether pathology 1 or pathology 2 here is most correct, you are still outside the guidelines for active surveillance and surgery or radiation is still the top recommendation you will find in dealing with your cancer. And your case is more likely in a high risk group that away from it.

Tony
Prostate Cancer Forum Co-Moderator


John T
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Date Joined Nov 2008
Total Posts : 4226
   Posted 12/23/2009 12:45 PM (GMT -6)   
When Gleason designed the score it was based on a visual system of grading that 90% of pathologists would agree on when seeing the same thing. So by defination you will have 10% disagreement if everything went well.
JT

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.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/23/2009 12:47 PM (GMT -6)   
mel,

when you ask for a second opinion,you get a second opinion, lol. the reading of the slides will always have a real heavy subjectiveness to it, depending on who is reading and their experience level. right now, to swap from a 4+3 to a 3+4 is better, but the only report that is really going to count is after your surgery, when they have all removed materials to examine. it may stay the same as now, go back the other way, or get upgraded. your two reads are still pretty close together, sounds like you are an honest gleason 7 case.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 310
   Posted 12/23/2009 2:04 PM (GMT -6)   

"Mel...don't know if you have had the chance to look at what a grade 3 cell or what a grade 4 cell looks like, but I will tell you this...even to the untrained eye there is a difference."

"When Gleason designed the score it was based on a visual system of grading that 90% of pathologists would agree on when seeing the same thing. So by defination [sic] you will have 10% disagreement if everything went well."

Both true to a point.  An exemplar Grade 3 is distinctly different than an exemplar Grade 4.  The problem is that in real life malignant prostate cells do not present as exemplars but rather fall on a continuum from Grade 1 to Grade 5.  Where on that continuum does a cell cease being a Grade 3 and start being a Grade 4?  That's very subjective.

Zen9    

 


No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 12/23/2009 2:30 PM (GMT -6)   
Second opinions can really suck when they don't match the first...Makes aperson really want to go out and get a third and then go with the Average Number.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 12/23/2009 2:35 PM (GMT -6)   
True. But in my case, it's more psychological than anything else.
 
The bottom line is that the treatment choice is the same and the big test/information will be the surgery pathology results.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/23/2009 3:03 PM (GMT -6)   
That's the nice thing about having a Gleason 9. Not much argument about that ! All three pathologists agreed.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/23/2009 3:36 PM (GMT -6)   
goodlife, that's the unfortunate truth, with your Gleason 9, there is nothing to dispute with the numbers. But you are still doing so well.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place

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