None of this stuff is black or white, it's all subjective. That includes PSA, biopsy result, surgical path, MRI, various scans or whatever test you've heard of.
The difference between a Geason 3 and 4 under a scope is tiny. In spite of years of training the pathologist regularly see's 3.5's. Usually he/she doesn't toss the coin in front of the patient but a decision has to be made.
He/she could say 3 and risk under treatment or say 4 resulting in unnecessary Tx with it's concomitant side effects.
No, F8, he can be wrong, just like anyone can. Someone else pointed out that with 2 G6 opinions, and with one G8, this is possibly the worst place to be. If he is a real G6, with a good chance of going AS and having a long haul of no intervention, then life is good. If he is really a G8, then treatment needs to start NOW, and it needs to be aggressive and immediate. No middle ground.
Rather than sniping about
it, let's ask the question--what would "I" do in this scenario. I can't imagine the nightmare the OP is living. If this were me, I might...
Take the third report to my docs at MDA and say, ok, here we are. What now?
Get that MRI and Genomics test
Maybe another PSA to see if it is changing and how fast (this would tend to confirm the G8)
And then, I would make a decision and pray that it was the right one
To the OP--this is the toughest treatment decision I've seen in this forum for a while. All any of us can say is to try to be at peace with the uncertainty and make the best decision you can. We are all still here for you.We totally get that everything is subjective. It’s usually not SO subjective to have two people see nothing but 3+3 and another skip 3+4 and 4+3 and go straight to 4+4. We did receive a message from the Doctor at MDA this morning saying he has asked the pathologists to weigh in on the discrepancy and also pointed out that tumor grading is subjective. My frustration is that we were told at the appt in December that they had asked their pathologist to take another look to confirm their findings as they were all quite surprised by such a large discrepancy. We were told they had not yet heard back. We wrote messages a couple of times to a couple of different people after asking whether they had ever heard back from the pathologists and if they still stood by their diagnosis of G8. We never did receive an answer. Eventually, I gave up asking as by that point we wanted the slides sent to JH. I also understand they deal with tons of patients and a lot of heavy stuff and they have to remain clinical. This is everyday stuff to them and not that big of a deal since we have another biopsy scheduled in March. For US, however, this was a huge gut punch and has caused us a ton of stress and anxiety over the last six weeks.
I’m sure Epstein can be wrong occasionally. We looked at it like we could end up with one of two scenarios. Epstein would concur with either the G6 or the G8 and be the “tie breaker” or he could come up with something in the middle. I’m really glad the latter didn’t happen giving us a third diagnosis! Yikes, that would have made my head spin.
Halbert, thank you very much for your very kind post. I appreciate the understanding. We did have the OncoDX genomic testing. It came back with a low risk score of 23. That definitely leans more towards supporting the G6 diagnosis. I never put much stock I to that as it was only looking at 4 tiny cores of tissue that were graded at G6 so I wouldn’t have expected anything other than low risk. After the MDA diagnosis, that test became a little more meaningful.
Lastly, (because my signature doesn’t seem to be posting even though I’m checking the box to include it), they ran a PSA at MDA on 12/16. The result was 6.2. His biopsy was 9/30. His PSA’s prior to biopsy were between 4.1 and 4.8 (different labs, different days). One run by the uro, one by 4K score lab, and one by us because we wanted PSA total and free. The doctor at MDA was not concerned. I’m sending him to the lab this week for another because we are curious as to whether it’s come back to down to pre-biopsy numbers.