How many of you had upgraded Gleason after JHU second opinion?

I'm sure some here (paging TA) could tell you the numbers that were upgraded or downgraded. I do know that most second opinions of the biopsy do not change. For my part, I was upgraded G8 to G9, but I've seen others here that were downgraded.

Hope you can do AS! Keep us posted. (BTW, I also had my MRI at UCLA...bummer that the machine was down.)

Are you looking for case-by-case stories/anecdotes, or the big picture?

Big picture: Epstein recently reported that he found Gleason score changing differences in about 15% of cases submitted to him for 2nd opinion. Among those 15%, he upgraded about 50% & downgraded about 50%.

Post Edited (NKinney) : 4/5/2018 1:56:06 PM (GMT-6)

Well, mine was "sort of" upgraded. First pathology report was done by the service (Dianon Systems) used by the Urologist that did my biopsy and came in at 3+4. Then, prior to my treatment at UFPTI, it was reevaluated by Shands, Jacksonville and upgraded to 4+3. Finally, John's Hopkins confirmed the 4+3.

...Jerry

Well we just got report back. I don't think it's particularly good news and we are done with idea of AS.

There were (2) cores 3+4=7 (80%, 60%) positive, with 10% being Gleason 4. There was perineural invasion identified in that one.

There were (2) cores 3+4=7 (90%, 70%) positive with 5% Gleason 4.

Then 3+3=6 in (2) cores (60%, 90%)

The perineural invasion part is a concern. I read that with MRI we might see extension. Right? Also read that staging when there's PNI is often not reflective of seriousness of situation.

We are hoping for seed radiation now. Am I right that removal of prostate, at this point, is not a great option, given the likelihood that cells have escaped? I'm under the impression that radiation done AFTER surgery has a higher incidence of side effects.

Any input is highly appreciated. We won't see oncologist until after MRI, which is postponed to maybe next week.

Thank you!

Stray: Don't rule out or fail to investigate SBRT. As good or better on recurrence rates and most usually much better on SE's.

May all beings be well always free from oppression.

Roger

Thanks Mary!

I need to research those other options better for sure.
We have brachytherapy in our heads, as it was the treatment mentioned by our oncologist (medical oncologist, not radiation guy) as being best bet. We meet with him again soon hopefully, and I’ll ask him about the other options.

I do remember him saying the external beam radiation was less of a good option but I need to clarify why. This is a well respected and leading oncologist in the area of prostate cancer. We really trust him so far. But he does not have our latest Dx info and we were all trying to be optimistic about Gleason 6.

Did your husband get an MRI and was there extension?

Thank you!

Also sorry about your Gleason, I had HDR BT and the procedure and post op was a breeze. Worth looking into. Denis