HealingWell
Search Close Search
☰

Second Option on Pathology

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 5/30/2018 6:27 PM (GMT 0)
My initial biopsy listed tumor grade and Gleason score for each of 12 cores tested.

My post-surgery pathology only listed an overall Gleason score (3 + 4 + Terchiary 5). I had SVI and EPE, and am guessing that the grade of cancer in the SV or EPE regions would be of great interest. The general idea being what grade cancer cells have already moved out of the prostate.

I am thinking of sending my slides to Epstein for analysis. Does Dr. Epstein also only provide an overall Gleason core, or does he provide data for the different samples provided (I had a total of 30 samples, 2 of which are SV).
Posted 5/30/2018 6:35 PM (GMT 0)
My post-surgical pathology looked a lot like yours, and I too had IMRT after PSA began to rise.
I doubt that a reading of your slides at this point would yield any useful information. You know the surgery did not get all of nasties. If you learned now that there were G4 or G5 cells in the EPE, would that affect anything you do now? I don't think so. The key at this point for both of us is just to track PSA on a regular basis.
Posted 5/30/2018 6:48 PM (GMT 0)
It's really just to satisfy my curiosity.
Posted 5/30/2018 6:58 PM (GMT 0)
I've never heard of anyone sending surgical specimen to Epstein for analysis. I can't imagine why anyone would want to do that. Post-treatment, there's really nothing that one would do different with or without the results.

But if you want, call the office and ask: 1-800-997-5475

Be prepared for them to ask you, "Why???"

Post Edited (NKinney) : 5/30/2018 1:09:04 PM (GMT-6)

Posted 5/30/2018 7:07 PM (GMT 0)
There generally isn't the need for second opinions on a surgical pathology since the entire gland is available rather than a very small sampling from the biopsy. Unless you suspect the pathologist was inept, but that doesn't look like the case. As for what grade escaped the prostate, by definition you know that what escaped was either G4 or G5, and probably both. A G3 doesn't leave the prostate area. You don't need a second opinion for that and what escaped was not in either the biopsy or pathology sample.

And you are confusing the biopsy care sampling with the entire gland pathology. Since you have the entire gland you would not send the biopsy samples for a second read.

I suggest you check with Epstein regarding a second opinion of the surgical pathology, but be very clear that it is not a second opinion on the original biopsy slides. They are superceded by the surgical pathology. Since you are curious, I suggest you get much more specific about the curiosity. Just what are you trying to determine that you feel is lacking or unclear regarding the pathology? I agree with fiddle, what do you suspect you would learn that would make a difference in your treatment direction?

Before you do anything, talk to your doctor that is leading your treatment regimen. I am sure if he/she needed another read it would already have been done. Who is directing your treatment? I trust it is a medical oncologist that is very well experienced with high risk advanced prostate cancer. If not, I would be spending my time getting the very best prostate cancer medical oncologist that has vast experience with cases like yours.
Posted 5/30/2018 7:10 PM (GMT 0)
To piggyback on that, I've never heard of anyone grading SV pathology other than positive or negative. Sometimes there will be mention of distal vs direct, but most don't even know what that means. I've tried to find that out myself. Suffice to say you are T3b with tert 5, and PIN to boot, which is bad enough. Do you really need to know anything more?
✚ New Topic ✚ Reply