Gap in biopsy Gleason vs pathology Gleason

How common is it for a person to have a gap of 2 points or more between their biopsy Gleason and their pathology Gleason?

I noticed that a new member of HW indicates that his biopsy was G7 and pathology was G9.

-Gedman

I'm one of the unluckily ones...
7(4+3) to 9(5+4)

I was one of the lucky ones whose score went from 4+4 Bx to 3+4 pathology. Only one core was 8, and only 2 were 6, the rest clear or indeterminate. So I thought I was in the clear but there's that one tiny surgical margin in the pathology report and PSA creeping up. So being pessimistic I figure whatever is making PSA now is 8. I'm going to Myers in mid Sept to figure things out. I keep thinking I should get a second opinion on the pathology slides if that's possible this many months after surgery. Maybe that would improve the chances of finding the actual location of bad cells better than any scans would. Myers didn't ask for me to do that though.

I went from a 7(3+4) to an 8(4+4). That's pretty close to a 2 point jump, if you think of a 7(3+4) as more like a 6.

-Bob

I am another guy whe went from GS7 to Gs9.

Tall One: I think you typed less or equal and greater or equal when you meant simply less than and greater than. As currently written you put Gleason 7 men in all three categories you mention.

Gedman -- you remember dana Jennings, the new York times editor who blogged about his prostate cancer? he went from G7 to G9.

ed

gedman said...
How common is it for a person to have a gap of 2 points or more between their biopsy Gleason and their pathology Gleason?

I noticed that a new member of HW indicates that his biopsy was G7 and pathology was G9.

-Gedman

I would say very common and that would be + or -, given that biopsies are only samples to determine patterns while a pathology Gleason is a slice of the prostate for a final examination.

Bottom line is that the path score is what counts since it'such mire comprehensive . The bx is just a small sample.
Bob

The individual reporting of upstaging or downstaging after RP should really be accompanied by a statement clarifying who performed your biopsy pathology…was it someone from the general pathology community, or were your biopsy samples sent to one of the small number of PC pathology experts? Epstein wrote:   " We have done numerous studies showing the reproducibility of Gleason scores in the general pathology community , " looking at the Gleason grade based on a biopsy, and then comparing it to the actual specimen removed during surgery, " and found that by and large, the Gleason grading that's performed is disappointing. All across the map, it doesn't correlate with what you see in a radical prostatectomy. People are having decisions made -- surgery or radiation, or watchful waiting -- based in part on a Gleason grade, when it's not accurate at all ." Epstein’s studies at Johns Hopkins show that the once-prevalent (especially prior to the ISUP 2005 Consensus*) under-grading of needle biopsies have been nearly eliminated… when read by a PC expert . . So, to add value to the discussion in light of this data, when you speak to your example of grade change, include a mention of who read your biopsy slides. (Full disclosure:   My own biopsy was read by Epstein, and did not change at RP pathology.)     *The impact of the ISUP 2005 Consensus is notable.   PRIOR to the pathology standards changes, 45% of all prostate needle biopsies were 3+3, and only about 30% were 3+4.   (about 15% were 4+3, and about 7% were >7.)   AFTER an initial “bounce”, the contemporary results are about 39% 3+3 and 35% 3+4 (and essentially no change to 4+3 and higher).   Gleason 3+3 is still the most frequently reported biopsy outcome.