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Tomz55
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Date Joined Apr 2011
Total Posts : 6
   Posted 4/28/2011 2:15 PM (GMT -6)   
I would like to know what is the Gleason score for the following
biopsy results:
Tumor found in 1 out of 12 prostatic tissues.
The Tumor score is 4 (gleason). This tumor replaces about 10 percent of
the tissue and less than 5 percent of the total tissues.
No other Tumors were found.

Two strange things:
First, There is only one number, not two.
Second, The tumor found was less than 50 percent, so it doesn't meet
the Gleason criteria.

So, The Gleason score is 4*2=8, or a second biopsy is needed?

shortyjack
New Member


Date Joined Apr 2011
Total Posts : 1
   Posted 4/28/2011 2:25 PM (GMT -6)   
To Diamonds3:  I am in your same shoes.  Just recently my husband was diagnosed with cancer, PSA 7 and Gleason score of 6 with perineural invasion present (according to the biopsy report).  Next week bone scan and CT scan of abdomen and pelvic area.  Have had slides sent to Johns Hopkins for a second opinion and have scheduled an appt with Johns Hopkins for a consultation and review of all tests.  They insisted on the slides so they can do their own pathology reports.  I understand sick to your stomach.  I have no appetite since diagnosis and have been on internet constantly trying to find the best treatment options.  All doctors agree he will need surgery, so we will wait for scans and go to Johns Hopkins.

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 4/28/2011 2:40 PM (GMT -6)   
I think the post from shortyjack has wound up in the wrong thread. Steve N' Dallas, are you here?

Tomz55 --- your question is a good one, and puzzling to me. Others may well have an answer. My guess would be that the only tumor tissue found was Gleason 4, so that would be an 8. Also, it seems there is very little of it --- a small tumor caught early. I wonder what your PSA is? What prompted the biospy?

I'm quite sure a second biosy isn't needed, but getting a second read by a different pathologist is always a good idea.

I'll be watching with interest to see what others have to say/suggest.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

142
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Date Joined Jan 2010
Total Posts : 6978
   Posted 4/28/2011 3:28 PM (GMT -6)   
Tom,
 
Did you actually get a printed copy of the biopsy report?
 
This sounds like it may be 4+4, but I would sure be asking questions of your uro.
 
I don't think there is any minimum % of tissue to assign a Gleason score. If they see just one cancerous cell, and it looks like a 4, 4 it is. In fact, on my report, it does say for some cores that the only pattern found was 4, and they are written up as 4+4 in the summary.
 
Ah, and by the way, Welcome to HW - and I'm sorry you find the need to be here, but the company is good.
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5854
   Posted 4/28/2011 3:32 PM (GMT -6)   
The biopsy report as you presented looks like it was written by a general pathologist with little knowledge of PCA. definitely get them reread by an expert in pca pathology, so you know what you are dealing with. If he/she writes em like that , how well can they be read by that person. I would probably ask for my money back on that one.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5854
   Posted 4/28/2011 3:34 PM (GMT -6)   
ps. no need for 2nd biopsy, just need to be reread, the slides are kept and can be directed elsewhere for a re read
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/28/2011 6:11 PM (GMT -6)   
They used to have (2+2)=4 and (2+3)=5 and even Gleason score of 1 supposedly, in the old days. They have thrown those out we have heard and lowest now is (3+3)=6 so Gleason 6 is the new sheriff in town (lol). Just remember that HGPIN although not cancer yet....is still highly significant, read that often ploidity DNA analysis on HGPIN is often Aneuploid which is the worse of the 3 ploidy types that can be tested for...I believe I read it in the new PaactNewsletter issue-Molecular Pathology by Dr. Chinn,( hard to believe that I know). A copy of the pathology report should clear up this discussion, hopefully!!!!

My brother had (3+3)=6 (Gleason 6)     5%< in one core- the definition of indolent PCa (fyi)
 
Maybe yours is  (2+2)=4  (Gleason 4)  and low percentage found in one cores or two would make it low like another indolent version...if that is what is actually is showing.

Post Edited (zufus) : 4/28/2011 5:18:02 PM (GMT-6)


Tomz55
New Member


Date Joined Apr 2011
Total Posts : 6
   Posted 4/29/2011 3:51 AM (GMT -6)   
Hi again,

Thank you all for your answers.

The exact pathology report:
"""
One out of 12 prostatic tissue cores (core 1, left lobe) shows foci of acinic prostatic adenocarcinoma (0.2+0.3 cm).
These foci replace about 10% of this core tissue volume and less than 5% of entire prostatic tissue cores volume.
Gleason score = 4+4 = 8.
The other cores contain foci of atrophic glands.
"""

So, the tumor volume is about 10% of one tissue?
Is this a common biopsy report or is it unusual?

Thanks a lot !!!!!

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/29/2011 7:51 AM (GMT -6)   
If you get 12 biopsies, there are 6 slides used, they have a way of cutting the biopsies in halves and display two sets of 2 samples on the slide, but it is 2 samples used and not four samples when you look at the slides themselves. Slides are sealed with a wax and kept good forever, in theory. Normal looking biology class type glass slides, they put a plastic cover on the top slide, to keep them from scratches and for better visionary use I was told.

You have a Gleason 8 then, which I didn't understand what your were saying originally, and with low volumes of percentages found in those 2 cores used to make a combined Gleason score. I had some 7,8,9's in my findings (2 of each of those and about equally in volumes) and PNI found. Here is what this stuff looks like under the scope:

www.yananow.org/Mentors/RobPBiopsy.htm    (plus some info on pathology also written by Terry Herbert the forum moderator...plenty of excellent PCa info found there). I took possession of my 9 yr. old slides like 1-2 months ago now, they store them for you...you can get them or send them out for review by the real patho experts if you are interested. You would be amazed at what specialized testing can be done by Dr. Bonkhoff and a select few others, Uro-Cor might even have a list of tests too.
 
Let me mention that PCa is far from perfect science, you could have missed biopsy areas (easily), you could have miss scored Gleasons, you could have a variant type that most regular pathologist could be clueless on. Not to scare you but inform you of what we are up against in decision makings. If you want to see a link to 24 know variants it is posted also at www.yananow.net/24Variants.pdf   (U of Mich. recently found such, prior it was 18 known).
Your pathology known right now, could be exactly what you are dealing with and hopefully that is the case.

Post Edited (zufus) : 4/29/2011 7:01:56 AM (GMT-6)

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