I don't think Epstein was wrong. The prostate specimen is step-sectioned at 4-mm intervals of the gland. A small amount of pattern 5 could be contained within one of the 4 mm slices, unseen by the pathologist (also if a second opinion).
The biopsy needle could have hit one of those small pattern 5 spots, and it was seen by Epstein, perhaps it was tertiary pattern 5? (4+3 with tertiary 5 become 4+5 if seen in a needle biopsy).
Prostatic Adenocarcinoma Grading said...
For needle biopsies
The predominant pattern is given first
The second most predominant pattern is given second, e.g. Gleason score 3+4 as long as the second score applies to >5% of the carcinoma
If the tertiary pattern is higher than both of the first two, it becomes the second pattern, regardless of its prevalence, e.g. 3+4 with tertiary 5 becomes 3+5
As for needle biopsies except that a high tertiary pattern is reported simply as a tertiary pattern e.g. Gleason score 3+4 with tertiary 5
Thanks for that explanation. If I understand you correctly, the biopsy samples probably contained 4+3+5 which was reported as 4+5, and matched the post surgical was 4+3+5.I recall (or I think
I recall) one of TA's explanations from about
a year ago. The first number is the predominant pattern, and the second number is the "next most serious"
pattern, or something like that... So the pattern 5 would take the place of the next most prevalent
pattern, which was 3. Or something like that.
In my case, it was simple... everything was grade 4. Well, except for a couple of cores that were 15% 4+3, which I usually never even include. But I've "upgraded" my sig just for this special occasion!
2014-15: PSA's 9, 12, 20, 25, Neg DRE's, false neg TRUS biopsy
6/16: MRI Fusion biopsy, 6+ Right Base, 2x40%, 2x100% G8(4+4)
8/16: DaVinci RP, 3 foci EPE, PNI, 11 LN-, 53g gland 25% Gr4, BL SVI, pT3b
1/17: started 18 months Lupron, PSA's ~.03
5/17: AMS800 AUS implanted, revised 6/17
8/17-10/17: RapidArc IMRT 39 tx (70 Gy), 4/18 Dx Radiation Colitis
1/18, 4/18, 7/18: PSA's 0.0, T=9