Percentage of prostate tumors upgraded after prostatectomy

Mine went up too. I'd venture to guess that more then 70% go up.

There are stats from Hopkins that, if recalled correctly, 32% of Gleason scores go up on post-surgery pathology exam, and only 2-3% of the scores go down.

Check Hopkins, there are real stats and not just anecdotes on this topic.

The stats do, however, make the WW/AS call tougher with a Gleason 6 biopsy score, and should help those with Gleason 7 (3+4) biopsy scores realize that they need to act, and not sit and wait.

It was said to me from the beginning, that at best, the pathology report of a prostate biopsy is but an estimate. Sephie's point of the number of positive cores and/or the percent of cancer in those cores is an important factor. A Gleason 7, any variety, has the potential of being a dangerous animal, and I couldn't imagine many uro/surgeons or oncologists telling someone that it's safe to wait with a "7".

Another factor to consider, is how much HGPIN (High Grade PIN) cells are found in the biopsy sample, as it can very well indicate a lot more cancer cells in possible formation. My own uro feels strongly about HGPIN, but with regular PIN cells, the potential danger is not considered as strong.

AS is still a good possibility if one meets the right criteria, no doubt. Many of us wish we had met those numbers. But we are talking of course, a Gleason 6, 1-3 cores max positive, with 1-10% cancer max, and no family history.

David in SC

I am also in the upgrade camp. Biopsy had my gleason at (3+4=7). Pathology upgraded it to 8. I can't understand how the biopsy could have been that far off. I can help but wonder it the 3.5 months that I waited for surgery thinking I was a 7 was the cause of my BCR.

I was also upgraded
I went from 3+3 to 3+4

I heard it was about 30% of men got upgraded, but I'm pretty sure I heard that a while after I'd already opted for surgery.

Common sense told me that whatever treatment I opted for the certainty was that the cancer was going to get worse over time and I'd rather be in the position of having acted too soon than too late. (And as it is I already had seminal vesicle invasion, a biopsy was never going to find that either as I've heard sticking biopsy needles in the smeinal vesicles is not a good idea.)

This is another aspect of PCa, and the diagnosis thereof, that convinces me that there needs to be a major advance in the way biopsies are done as far as equipment and technique goes, such as using high quality imaging devices of some sort to allow all the sections of the gland to be sampled in a comprehensive manner that eliminates as much as possible of the hit and miss aspect.

yes it's only a sample but it needs to be a better sample.

If the Da Vinci equipment is the equivalent of a 16Gb memory stick, then the "gun" that did my biopsies looked like the equivalent of a Betamax tape - clumsy, old fashioned, inflexible (literally and metaphorically) and it was even beige! (The computer screen was so primitive it looked like the computer wasn't even up to running MS-dos)

For those of us who have been upgraded it's too late to do anything about it, but perhaps we should still all say something about this to our uros in the hope that it will encourage someone to improve things and make things better for other guys in the future. A lot rides on a biopsy, a h#ll of a lot, and it should be better than 70% accurate.

Alfred

Percentages are interesting and so are anecdotal stories. (For the record I went from 3+4 to 3+4 with tertiary 5) Even the professionals can only be a guide. One oncologist tells me the tertiary 5 cells are of no consequence; a urologist tells me that I should consider my Gleason score to be an 8. Dandy.

Real world says there is a 100% certainty that I had cancer. Most, maybe all, was cut out one year ago today. That there is a 90%, or 80%, or 70% chance that it is gone means little to me. They either got it or they didn't; there is 100% success or 100% failure.

I read that the mean time to biochemical failure for someone with my stats is 5 years. Again, interesting but of no help at all. In fact, knowing that is somewhat depressing unless you understand that those without biochemical failure would not be in the sample. That is where the professionals come in; they help you process and understand the conflicting information. However, I still don't know any more about where I'll be in four more years.

Any decisions are ours alone with no way of ever knowing if we made the correct one or not. There are no redos. Me? I know I made the right decision for me. Someone with the same medical information might have chosen differently. Again, the decision is there's. At no point in the process is there too much information just, possibly, more time needed for processing it.

Gimpy and others,
Upgraded Gleasons are about 30%; progressions on AS are about 30%. I don't think that this is a coindence. The vast majority of progressions I believe are due to initial biopsy error, not PC growth.
If knowing for certain didn't have a price I would be all for it.; but the price to know if you have an upgraded gleason is severe. 10% chance of severe incontinence, 70% chance of leaks after 2 years. Very high probability of ED and about a 90% chance of a somewhat reduced sex life and a major invasive surgery. If this added to survivability it might be worth it; but it doesn't.
Now that you found out your Gleason was upgraded what decision do you make, NONE, you just get psa tests every three months like everyone else and hope for the best. There is absolutely nothing you can do if your gleason is upgraded from a 6 to a 7.
Tud said if perfectly, get a doctor that is familiar with AS and if your initial biopsy was wrong it will be known within a year or 2 and you can be treated with the exact same cure rate. I know this is a difficult concept to grasp that the cure rates are the same if you delay treatment for a couple of years, but all of the data is consistant.
I myself would never go on AS without getting a color doppler ultrasound biopsy. It is non invasive and highly accurrate in spotting any cancers that are dangerous and can confirm an insignificant cancer. It can also be used as a baseline to identify any future progression.
In no way am I advocating that a G7 or a large volume G6 not be treated. But again a clinical pathology from surgery will result in more knowledge, but what do you do with that knowledge. Your psa will either remain stable or rise regardless of your clinical pathology. You make a decision on your psa rise not on the pathlogy, same as if on AS. In some cases as in a high volume G8 or G9 a clinical pathology can result in an immediate decision to do adjuvant radiation, but these cases are rare and not applicabible in G6 cancers.
JohnT