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Question about biopsy 2nd Opinion

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Posted 4/8/2012 2:35 PM (GMT 0)
I'm 49 and on my second biopsy (3/16/2012) the results came back with one core positive, 10% to 15%, Gleason 3+5=8 - not what I wanted but I felt somewhat good that it was only one core and a small percent.

Given that I have some 5 in there, I wanted a second opinion so I requested my slides and sent them to John's Hopkins.

Hopkins came back with a Gleason 4+5=9 and 40% of the core - pretty different from the Northwestern pathologist.

Now my real question - as I read the report from Hopkins, I noticed they only received one slide, the originally reported positive core, they did not receive any of the other 12 benign cores. When I asked for my slides, I assumed I was sending all of them for review, not just the one. Is it normal to only send the "positive" cores?

Given the difference between Northwestern and Hopkins on the one positive core, I'm really wondering about the remaining cores - I would have liked to have had them all reviewed.

On the other hand - from what I can tell the slide was not reviewed by Epstein @ Hopkins - so does their reading really carry that much more weight than the pathologist @ Northwestern in Chicago? I'm seeing Dr. Catalona and I can't believe he's relying on "iffy" pathology reports.
Posted 4/8/2012 5:31 PM (GMT 0)
I find it very odd that they only sent one slide.
Even though Dr. Epstein is considered the expert, I would think all of the pathologists at Hopkins would be excellent given their reputation. At any rate, given that you are uncomfortable with this whole situation, perhaps you should have your slides sent to Bostwick Labs (the other expert most often mentioned on the forum), and make it a point that all the slides get sent this time.
Posted 4/8/2012 5:48 PM (GMT 0)
I would agree with Tigerfan's comments. Also, we can't expect the boss to be signing every pathology report, but we do expect a level of excellence from the leading labs. That would lead me to give a certain level of importance to the Hopkins report.

Bostwick has been very good to work with in my case.

This is a good example of one of the "risks" of multiple opinions. You get more information.

Posted 4/8/2012 5:51 PM (GMT 0)
There is not a whole lot of difference between a 3+5 and 4+5 pathology report but the 15% volume to 40% is considerable.  Either way you have an aggressive tumor that will need to be treated IMO sooner rather than later, but I am not a doctor or an expert.  In my case I had 2 cores positive with 3+4 at 15% and 20% but after my RALP pathology my Gleason didn't change but my tumor was 60% of my prostate. Hopkins and Bostwick are considered to be the two best labs. I used Bostwick for my Biopsy.

Terry

Posted 4/8/2012 6:05 PM (GMT 0)
They agree that you have Gleason 5 tissue. The difference in extent and/or Gleason 4 is going to be at least in part due to human factors. What is or isn't and what Gleason score it is, is a matter of opinion. You can find images of the different types on the web (or in printed phamplets) and they certainly left me with an appreciation of the sort of difficulty involved in classifying the stuff.

But the important factor (IMHO) is that both agree that you have Gleason 5 tumor. I don't think a third opinion will tell you anything more useful than that. And I don't think the two are fundamentally "all that different" in terms of what they will bring up for treatment concerns - the presence of any G5 does that all by itself.
Posted 4/8/2012 11:41 PM (GMT 0)
Worrying about the conflicting biopsy reports is just a distraction now..Your treatment choices and options are not going to change any based on one report or the other. You have aggressive, high-risk prostate cancer and your treatment should be based on that finding..

The only way to know FOR SURE what the extent of your cancer is to remove it surgically so the entire gland can be carefully examined and the need for any further treatment can be determined at that time..While it's true 60% of PC victims can safely take their time making treatment decisions, we G-9 guys don't have that option. You will want to move ahead with your treatment in a timely manner and get this taken care of..JMHO....
Posted 4/9/2012 12:08 AM (GMT 0)
I would think that Dr. Catalona would only use a pathologist that he trusts. Even top pathologists can disagree on a biopsy sample. The only way to know for sure is after the prostate is removed and examined.

Whether you have an 8 or a 9 shouldn't change your treatment plan, so I wouldn't spend too much time focusing on this.

Best of luck to you.
Posted 4/9/2012 12:47 AM (GMT 0)
I agree with Frankme and Fairwind. You know you have a PC that definitely rules out AS. I would be more concerned if has spread and if so how far. Start researching your treatment options and make a decision. One uro told me to set a decision deadline date and make it before or on that date.
Good Luck
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