Has anyone taken path slides to a different center and gotten new gleason score?

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LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 315
   Posted 1/7/2010 8:00 PM (GMT -6)   
Okay so finally we decided that my dad is going to do follow up treatment and Sloan Kettering in NY.
Since he did not perform his RP at Sloan, they requested to have the slides to look them over before his appointment on Monday.
My dad's pre surgery gleason was a 7 and post surgery became a 9. I heard that different centers can rate the slides differently. I am scared to death Sloan might change it to a 10 or something. Has anyone heard of this happening?
 
Thank you so much. Okay back to studying for my bar exam. I think if I was to take a board in urology I would pass it before this bar exam.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/7/2010 8:05 PM (GMT -6)   
Yes, it actually happens quite frequently, but most of the time it only varies by a point. Most of the time I have seen it go up.

Sometimes instead of a 3 +4, they might say 4 + 3.

Anyway, it is a good thing to have a second set of eyes.

Goodl luck on the bar !

Goodlife
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


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/7/2010 8:14 PM (GMT -6)   
Beauty, as they say, is in the eye of the beholder. One pathologist may look at a slide and see a certain grade of cell while another may look at that same slide and judge it differently, more so if it is borderline one way or the other. I had two different labs look at the biopsy plugs and both said 4+3=7. Post surgery the initial lab said upgrade to 4+4=8 while the second lab said still 4+3=7. I have a hankering for the second lab's result because they took the trouble to grade the cells at a point of extension (grade 3). Like they say though, it is what it is, and what will happen will happen regardless of whether it is a 7 or an 8. Same with your Dad. It's out, his follow up radiation hopefully will do what it has to do and whether it's doing it to a 9 or 10 shan't make any difference.
Best wishes for him,
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 1/8/2010 10:32 AM (GMT -6)   
 
My post surgery score was 3+3 after my PSA started to rise they looked at it again and sent it to John Hopkins and it came back a 4+4 that is why I also recommend getting a second opinion on your final Path report.
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 1/8/2010 10:43 AM (GMT -6)   
Because of the MD's I used in two different geographic locations, I had to send the slides out for a second read by another group.  In my case they came back rated the same.

51 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
PSA at 0 for just over a year now.
 
 


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/8/2010 3:39 PM (GMT -6)   
Wasn't there some famous quote by some author that went something like:
"If you want to know the time ask a man with one watch. The man with two is never sure."
Jeff

wigged-out
Regular Member


Date Joined Dec 2009
Total Posts : 130
   Posted 1/8/2010 3:47 PM (GMT -6)   
I have a second opinion coming up and had to call the lab (Bostek?) and have them send the slides over to the new Dr.. Had to fill out consent form, and they asked if I wanted to have the "stained" or "unstained" samples sent.

I had no idea, and asked what they normally do. They said most of the time they send the stained. After the second opinion, the slides then get returned to Bostek within 60 days. I don't think they charge for sending out slides, unless it needs to be Fed Ex'd.

Interestingly, they will do this for a second second opinion too.
Age: 53- good health, physical anyway. Tinkle alot at night- 4-6x's

DRE 11/08- no lumps, just enlarged prostate

1st PSA, total- 11/08= 6.1

2nd PSA, total- 8/09= 6.6 Referred to Dr. J. Hoeksema @ Rush Univ. Med. Center/Chicago

Needle Biopsy 11/09- 12 samples. 11 OK. Right Lateral Mid- Adenocarcinoma Gleason score 3+3=6 9 involving 5% of specimen. Prescribed Flomax for excessive peeing.
Second opinion scheduled 1/21/10 with Dr. Gregory Zagaja, Univ. of Chicago Med. Center


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/8/2010 6:20 PM (GMT -6)   
Yes I decided to go to another hospital and my gleason score got worse. Oh well glad I got it right.

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/9/2010 3:50 PM (GMT -6)   
It gets more complicated with the more knowledge you get about the variables:
 
12-14 variant types of PCa  (might not be defined properly too)
 
Ploidity analysis- 3 different types known as to cells DNA structures (cost extra to have this testing done....see Bostwick and other known experts for best analysis.
 
Then did they miss something inside your prostate gland, you can have multipule gleasons scores found within the same gland. I was found with 7,8,9's  (found 2-7's, 2-8's, 2-9's) also.
 
Welcome to the jungle, twlight zone and unknowns of PCa, it is beyond belief as to analysis, defining, treatments and various results. Alot of experts are far from being labelled as such and we get to try and navigate our best options....Atleast there are choices at this juncture.


Youth is wasted on the Young-(W.C. Fields)


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 1/10/2010 2:02 PM (GMT -6)   
"Pre" and "Post" are what those words indicate and I suspect it's a rare situation where someone's results are the same before as they are after.  Let it alone, and let your father and his medical team handle it.

Age:  60 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0

 


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 1/10/2010 8:07 PM (GMT -6)   

I agree with most here, however I wanted second opinion and sent slides to Hopkins. Epstein dowwngraded mine from 3+4 to 3+3.  It did give me some comfort but as my doc said, "It's still PCa" and therefore I still had to decisde what to do.

Now is the time for you to really be digging in for Feb bar exam.  Study hard, make your Dad proud. Give PCa to the Docs and God.

Ted


Background:
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
Stats:
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....
 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 1/11/2010 4:25 PM (GMT -6)   
I took my path slides from Duke to Sloan Kettering twice. On the biopsy and after surgery. The first set confirmed Duke's findings, on the second set, Memorial upgraded my staging, but agreed with the Gleason. My biopsy Gleason was downgraded after the surgery. So, this is a moving target and an imperfect science. Best of luck!

LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 315
   Posted 1/11/2010 4:29 PM (GMT -6)   
Hey Geebra, thanks for responding. Just a quick question: how did they upgrade your staging? I can understand gleason because its pretty subjective, but staging? I thought that is black and white, either you got cancer in the SV or not sort of thing. Can you explain to me exactly what happened? THanks!

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 1/11/2010 5:09 PM (GMT -6)   
The pathologist at Sloan saw a focal extraprostatic extension, whereas Duke's pathologist did not see it or did not consider it an extension. It happens. Sloan saw positive margins in two places, while Duke only saw one. It is a judgement call when the margins or extensions are very small.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

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