Post-op pathology differs in cancer location from pre-op biopsy

Tom,

Welcome to HW. Glad to hear that your surgery went well.

As to conflicts between the biopsy and post-op path reports, I think we all have them to some degree. My first question would be who did the two reports? The same lab? Different? For example, my biopsy was done by Bostwick, but the post-op path was done by the staff pathologist for the hospital group. Because looking at slides and assigning a Gleason score is very much based on the skills of the pathologist, variance is possible. It is also possible that the spot you are concerned with was very small, and not cut through so as to be visible to the pathologist.

You could have a second opinion on the biopsy slides, and the same on the path report, if this concerns you. Since the results are good in other respects, I would tend to take them and run.

I'd need - yes - no explanation needed to vote in your poll.

Let me try an analogy.

Say you have a can of Spam (not the internet kid, the meat kind), and it has a couple of peas in it. Or a pea and a kernel of corn, in your case.

In the biopsy, you walk up the side of the can and poke it with needles, pulling out core samples of what is in the needle's path. One core sample had some pea in it, and another had some corn in it.

Now you take the spam out of the can and slice it. In my case, there were 8 slices - in your case, read the report. Each slice has significant thickness. If the pea happens to be where a slice happens, it "shows up" and if the kernel of corn is between two slices, it's hidden by "spam."

Replace spam with normal prostate tissue, corn with one tumor and pea with the other, and you have "how that can happen." The post-pathology is not some sort of fussy process of slicing the whole thing whisper-thin and examining it - it's much more of a "gross" process in the not-yucky (though it probably is yucky) sense of gross. If they still have the tissue and you want to spend extra money, you could send them on a witch hunt for the kernel of corn, but I doubt your insurance will cover it.

In my case, one core of 12 had cancer (5% or 20% depending on which pathologist looked at it) but the post-pathology found multiple small tumors on both sides. Had the one needle gone slightly differently I'd have been "clean" in the sense of a negative biopsy result, but I'd still have had multiple bilateral tumors. It is not an exact science in many, many respects.

I believe the hospital lab that examined the prostate specimen after it was removed has to keep the slides around for awhile. If you really want more certainty you can have the the pathology specimen reexamined at one of the top pathology labs like Jonathan Epstein's at John Hopkins.

Thank you all for yoiur responses.  Collectively, they make me feel much better. I will take the goood results and run (as soon as I am able without completely soaking my shorts again).