post surgery gleason score

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Regular Member

Date Joined Nov 2009
Total Posts : 47
   Posted 1/29/2010 11:22 PM (GMT -6)   
I had surgery for prostate cancer on Wed the 27th.  The doctor said that everything went well and he would get with me on what was found with the prostate.  All tests before surgery indicated that the cancer was confined to the right lobe with a gleason score of 3+3=6.  I had a 12  core bio a couple of months ago that came up negative and the latest which was 18 core which showed a very small amount of cancer in two cores which were on the right side of the prostate.  The doctor just called and told me that my gleason score was now 4+4=8 and the bio of the prostate showed most of the left side with cancer with none on the right.  In checking my MRI records they indicated cancer on the right with no mention of cancer on the left side of the prostate.  Is it possible that all of their tests could be so far off?  What are the chances that there could be a mix up or misreading of the slides?  The doctor did indicate that there was no indication of cancer in the nodes and it appeared to be all contained in the prostate.  I have went from a little worred to a lot worred!
age 59
2007 psa .6
Oct 2008 psa 9.4
Dec 2008 psa 11
Bio done 12 core, no cancer
July 2009 psa 16
Sept 2009 psa 20
All DRE were normal
Made appoinment at Mayo
Bio, 18 core 2 positive, gleason 3+3 =6
doctor said T2
Bone scan neg, CT neg, MRI with coil indicated cancer still in prostate
Robotic scheduled for 1/27/10

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 1/30/2010 12:29 AM (GMT -6)   

MRI's are not great at visualizing PC. Most men don't have them. I suppose the radiologist could have gotten left and right mixed up, but doubtful.

As far as the upgrade from a 6 to an 8, that's a jump, but the good news is the contained as far as we know. We can tell more when you put your pathology on your signature.

Of course, there can be mix-ups, but with path slides it is pretty rare. I would say that once you know you have clean margins, you can breathe a little easier, and see what the PSA tests say.

Not a lot you can do at this point, and worrying won't make it any better, Just concentrate on getting the leaks stopped, recovering from the surgery, and being thankful for all the good results.

Tomorrow is another day.

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 injection
No pads, 1/1/10

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 1/30/2010 12:32 AM (GMT -6)   
Twotall. Wow that is quite a jump from 3+3 to 4+4. The good thing is that it seems that it may be organ confined. I guess when you see the Dr. he will want to watch you PSA Close. Time will tell how successful the surgery was. There is no reason to worry about the what if's. It will not change a thing. Live each day to the fullest and be thankful for each day.

Jeff T
Cajun Country
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.
15 months out injections Caveject (success)

Regular Member

Date Joined Dec 2009
Total Posts : 214
   Posted 1/30/2010 6:10 AM (GMT -6)   


Glad to hear that you are on this side of the surgery.  It appears that your recovery is coming along well.  That is certainly good news.

Also good news that the PCa appears to be organ confined.

Sorry about the upgrading of your Gleason score. 

Goodlife and Jeff T offer good advice about worry.  I can only echo their words.


Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 07/10.      

Post Edited (skeener) : 1/30/2010 4:28:10 AM (GMT-7)

Veteran Member

Date Joined Jan 2009
Total Posts : 2243
   Posted 1/30/2010 9:05 AM (GMT -6)   
You might call the Dr's office Monday and ask about the change from right side to left side to see where the mix up occured. The good news is the containment and the not so good news is the upgrade on the Gleason Score. But sounds like you have a lot to be happy about and as others have sugggested focus on that. And yes, that  is easier said than done, but worrying only does you good if you get up and do something about the problem, so call Monday to clarify your Dr's report. The best to you and hear's hoping a string of zeros on your PSA.
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10
Great family and friends

Veteran Member

Date Joined Apr 2008
Total Posts : 1132
   Posted 1/30/2010 9:08 AM (GMT -6)   
My biopsy was a 3+4 and post surgery I am an 8 (4+4). I would talk to the doctor.
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
20 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better

Regular Member

Date Joined Jan 2010
Total Posts : 87
   Posted 1/30/2010 9:18 AM (GMT -6)   
Two tall,

I had a 4+4 and all contained so that is your biggest issue. They should tell you beyond a doubt from the pathology where the cancer was contained. It has a predictable progression so if the cancer was contained in the margins and had not spread to the nodes and vascular bundles before that, then you should be good to go. Mine was contained, and that is the beauty of surgery over radiation. Then you'll get a psa blood test and it should read a very low number as in undetectable. Sounds like some one took some bad notes or had the film upside down.
PSA 8/2009 5.6 Gleason 8
DaVinci surgery 11/2009
Pathology - totally contained in margins -one bundle spared
PSA now undetectable
Continance: Night and morning fine; mid day onward still not there yet.
Trying Trimix

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 1/30/2010 9:46 AM (GMT -6)   
Sorry about the upgrade to Gleason 8 from 6. The key is for the cancer to be organ confined and get negative margins. hopefully your next PSA will give good news and peace of mind.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11.5 months test 1/21/10 result 0.004

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 1/30/2010 10:14 AM (GMT -6)   
Two Tall, glad you are on the other side, you are now in the recovery mode. Sorry about the upgrade from the 6 to 8, you must all rememember, that a biopsy is just an estimate, they are only seeing a small section of your prostate and none of the surrounding area. An upgrade like that is not uncommon, just unfortunate. It's more important, as time and future psa tests will tell, that the cancer was contained to the prostate. Good luck, you have made it this far, the gangs all here for you.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time

Regular Member

Date Joined Nov 2009
Total Posts : 47
   Posted 1/30/2010 11:07 AM (GMT -6)   
Thanks everyone for your thoughts, you have helped me step back and see the bigger picture.  I guess I was not expecting such a big jump in the gleason score and went into a tail spin for a bit.  When I talked to the doctor he indicated that he would have the slides double checked and get back with me.  My doctor will be out of the country when I have the cath. removed Wed, but I will ask for a copy of the bio report and post some of it then.  Every thing else is going about as expected, my wife and I learned a bunch about what to expect from reading the forum before we started what we are calling our "grand advanture".  Thanks again for the help and surport,
age 59
2007 psa .6
Oct 2008 psa 9.4
Dec 2008 psa 11
Bio done 12 core, no cancer
July 2009 psa 16
Sept 2009 psa 20
All DRE were normal
Made appoinment at Mayo
Bio, 18 core 2 positive, gleason 3+3 =6
doctor said T2
Bone scan neg, CT neg, MRI with coil indicated cancer still in prostate
Robotic scheduled for 1/27/10

Regular Member

Date Joined Mar 2007
Total Posts : 460
   Posted 1/30/2010 11:22 AM (GMT -6)   
I also had problems with the Gleason score biopsy said 4+4 post op score 3+3 then when my PSA started to rise they relooked and said it was 4+4.  I advise sending the slides to John Hopkins for a second opinion just to be sure, they all make mistakes.
Good luck and get well.
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 
12/28/09 PSA 0.5
Start radiation treatments ib January 18th. 

Regular Member

Date Joined Jan 2010
Total Posts : 75
   Posted 1/30/2010 12:34 PM (GMT -6)   
twotall, I think the key is what your post-op PSA test results are. You can look at statistics and nomographs all you like, but for you, specifically, if your PSAs are non-detect, that's all you are looking for. Conversely, if your Gleasons are 6 but post-op PSA continues to be detectable (and consequently rising), the Gleasons won't help you.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, no lymph node involvement (0/9), perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 "panty liner"/day, with minor leakage when I get up from long seated position
ED pretty complete: some erection possible but current non-functional

Regular Member

Date Joined Jan 2010
Total Posts : 25
   Posted 1/30/2010 11:01 PM (GMT -6)   

I'm in exactly the same situation as you are.

Biopsy showed cancer on the left side, MRI shows cancer on the right side and none on the left. Even, in my opinion, biopsy is the primary indicator, I'd still go with the worst case scenarion which is you (and me) might have cancerous cells on both sides.

One of the reasons I chose surgery. It's scheduled for the next Wednesday.

Good luck with your recovery.

Age - 54
Diagnosed - 09/2009
Gleason - 3+3
PSA - 6.7
4 out of 12 cores positive on the left side
MRI shows none on the left side and "cancerous" issues on the right side

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