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Question on Post Op Pathology Report

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Posted 5/1/2008 9:48 PM (GMT 0)
Not sure if this has been discussed in any previous thread as I've search but unable to find a definite answer. I've noticed quite a few cases where the Gleason and Stage scores have been upgraded from the original determination after the pathologist has examined the entire prostate when removed. I'm assuming that the latter is more accurate because the pathologist has access to the entire removed prostate. The question I have is what about the folks that took other treatments where the prostate is not removed. How can it be determine if the Gleason and stage are the same or need to be upgraded if the prostate is intact? Maybe I don't fully understood Gleason and stage but it certainly been bugging me since my scores were upgraded after surgery. All I know is the Gleason score and Stage tell the aggressiveness and stage of the cancer. Does it not matter what these scores are after treatment?
Posted 5/1/2008 10:23 PM (GMT 0)

I think you're right in assuming that the Gleason and staging are more accurate after the pathology from a removed prostate. The Gleason can go the other way too -- pre-op I was Gleason 4+5=9 and post-op 4+4=8.

It is a grey area and a matter of interpretation whether a group of cancer cells fall into one grade or the next. If you ever look at illustrations of the Gleason grades, it's so hard to judge -- even the pathologists sometimes don't agree on the same samples!

So my non-medical opinion is that the pre-op figures are generally "good enough". Of course it is better to have a whole prostate to test, but before treatment, the doctors have to do the best they can with what they can extract from you :-)

Posted 5/1/2008 10:59 PM (GMT 0)
It is a grey area, but I would have thought that most people would probably give more credence to post op pathology report because they have the whole prostate to look into. At the same time reverse also seem to happen as was for Piano !! So the jury is out. Is it worth getting a second opinion on post op pathology report ? Most of us get 2nd opinion on biopsy results, why not that many on post op reports?

The main thing is that the beast is out and the margins are clear;whether it be an upgrade or downgrade of the scores.
Posted 5/1/2008 11:11 PM (GMT 0)
Kris
If you go to this web sight http://en.wikipedia.org/wiki/Gleason_score
you will see that the scoreing is very judgemental. Of course the rateing on the entire prostate is the best, but you could have ten different clinisions evaluate the same sample and get several different ratings.

Be glad the devil is out and the margins were clear.
Posted 5/1/2008 11:43 PM (GMT 0)

Hey Krisp,

Hello, my wife does all the writing here on the forum, I just read and learn, so I hope I am doing this right.....

I have noticed that the biopsy gleason predictors and the actual pathology gleason scores are almost always spot on, usually no more than one point off, and I attribute some of that to the time laspe between biopsy and surgery. I think it is only natual to second guess everything when  you are going though the misery of recovery, Lord knows I have had my moments, and it only reinforces how important it is to get all the info you can before you decide on your course of action. You can find out a lot in six weeks, the average waiting time between biopsy and treatment, and you don't want to be on this side wishing you had asked your Doctor about this or that, so I applaud anyone who helps the new guys by sharing their experiences. Has certainly helped me and Cindy.

Kent

Posted 5/2/2008 12:02 AM (GMT 0)
Thanks for all the replies but I guess I didn't do a good job in asking my question. So I'll try again.

We know that the post surgery pathologist report is the most accurate. So here is my question - Folks that took other treatment, and still have their prostate intact, cannot really say for sure what their scores are since the only way to detemine this truely is to have the entire prostate out for the pathologist to examine.

Hope I did a better job this time around.

Sorry

Kris

Posted 5/2/2008 12:27 AM (GMT 0)
Hi Kris,
I agree largely. This is why there are more having surgery than any other primary treatment. Though I will add that this does not necessarily mean better results with surgery over say radiation or in advanced cases hormone therapy. But you will find many of the other techniques won't be offerred if the disease is known to be more advanced. My post operative pathology was predictable because of the high PSA and it was largely different than the clinical pathology. Many doctors would argue that mine was inoperable but I'm glad we removed it. I am also glad I know where I am. I have had the ability to add adjuvant therapies hoping that this does not come back. Still living, hoping...

Stay Positive.

Tony
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