when pathologists disagree

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Regular Member

Date Joined Sep 2010
Total Posts : 309
   Posted 9/30/2010 8:12 PM (GMT -6)   
We had Carter's slides read by Dr. Epstein at Johns Hopkins. I wondered what I would think if his report was different. It IS different, but not substantially. He saw only 10% in the one core (out of six) as opposed to 20%, which is good...but maybe not much of a big deal. Gleason remained the same, 3 +4=7. But what seemed stranger was that he saw high grade PIN on the side with the malignancy and none on the other side. The original report was just the opposite. I don't know what to think. Could there be a mistake? If so, which one?? The second (PIN near the tumor) makes much more sense, and makes me feel better.

We have a consultation with a radiation oncologist Monday, and will take both reports. We are having the PSA's from the last few years sent to the radiologist. Not sure if there is anything else he needs to see, other than a list of meds Carter is taking.

Unsure what will happen next, but Carter is leaning strongly toward radiation. We have read and read. I am hoping that after Monday we will have a clear direction.



Veteran Member

Date Joined Jul 2010
Total Posts : 3892
   Posted 9/30/2010 9:07 PM (GMT -6)   
I would not worry too much about the pathologist mix-up..It's the Gleason 7 that counts and no matter what treatment you choose, the entire organ will be targeted..

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 10/1/2010 4:30 AM (GMT -6)   
That's kind of the downside to second opinions....Makes ya want to get a third one....

anxiety out the roof
Regular Member

Date Joined Aug 2010
Total Posts : 111
   Posted 10/1/2010 5:58 AM (GMT -6)   
I'm findind out the this is an emotional up and down disease. It seem the more info we get- the more confusion, different opinions and rollor coaster ride there is.

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 10/1/2010 6:51 AM (GMT -6)   
roof- you are understanding PCa more and more, roller coaster ride that can also continue from one loop to the next, sorrry to mention. Anybody whom thinks this stuff is slam dunk and simplistic perfect science...this is just one minor example of why it is not that. I would take Epstein or any of the known experts over a local pathologist (average type), if it were the only choices, 3 rd opinions have happened too. Best to you moving forward.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 10/1/2010 11:15 AM (GMT -6)   
I would always go with the expert's opinion. In your case there is very little difference that would affect your tratment options.

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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