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Should I have my slides sent to Epstein / John Hopkins?

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Posted 10/4/2019 3:31 PM (GMT 0)
As you will see from my signature below, my biopsy and subsequent pathology after RP from my local hospital (which has a reputable cancer center) said I was a Gleason 9. After my RP and my recurrence I went to MSK for a second opinion for further treatment (radiation) and their pathologists downgraded me to an 8 upon review of my slides.

I find it hard to believe that both of my original reports said I was a 9 only to have those downgraded to an 8. Don't get me wrong -- I'm happy with the downgrade. But I tend to believe MSK's report more than I do my hospital's (given MSK's excellent reputation), but I would like more assurance. Does it make any difference at this point or should I send my slides for a review by the very best, Epstein at John Hopinks, to put my mind at rest?
Posted 10/4/2019 3:43 PM (GMT 0)
General post op readings are more reliable than biopsy samples. I'd trust MSK's reading and doubt you'd get anything useful by sending out for a third read.

At this point, you're in the high risk group whether you're 8 or 9 and the treatment path is the same in either case.

The question I'd have is, "If I knew for sure, would I do anything different now?"

Andrew
Posted 10/4/2019 3:43 PM (GMT 0)
if it makes you feel better but i'm not sure in matters anymore.
Posted 10/4/2019 3:45 PM (GMT 0)
You could--but at your high risk classification, seriously, would it make a difference in your treatment? Either way, you're in for a lifetime of regular PSA readings and who knows what else?

If you'll feel better for having done it, by all means do it. I don't see how it will affect your treatment or outcome.
Posted 10/4/2019 4:50 PM (GMT 0)
I was a 4+4 from the biopsy, and a 4+5 from post op path.

I'll echo what others have said - it hasn't made a treatment decision difference to me over just under 10 years fighting the beast, so I'll ask Do you think it will make a difference in your treatment choices?

If you have looked at the samples of Gleason 4& 5 slides on the internet, I would think you will see that it is very dependent on who reads the slides.
Posted 10/4/2019 5:17 PM (GMT 0)
What Andy said plus your insurance might refuse to pay for it as it would be an elective procedure on your part..
Posted 10/4/2019 6:50 PM (GMT 0)
I can't see that further opinions would provide much useful information. You're high risk no matter which is true. When pathologists disagree about Gleason 8 vs 9 it's often the case that both have seen a small amount of Gleason Pattern 5 cells but disagree on whether they represent more or less than 5 percent of the sample. If they call it 4% then you're a Gleason 8 (4+4) with a tertiary 5. If they call it 5% or more then you're a Gleason 9(4+5). But there's not enough difference to make a difference; the treatments for Gleason 8 and 9 are mostly the same. The only difference is that Gleason 8 guys can be ever-so-slightly more hopeful that the treatments will work.
Posted 10/4/2019 9:58 PM (GMT 0)
I agree with the others. MSK is a great outfit and I would accept their interpretation at G8. If you did send it to Epstein and it came back as G9, it might only serve to give you unnecessary anxiety.
Posted 10/4/2019 10:19 PM (GMT 0)
You have had surgery and salvage radiation, your Gleason score is pretty much meaningless at this time. You just watch your PSA’s from now on. If you really wanted to do something, maybe look into genetic testing to see if you have any adverse DNA that might affect future treatment if needed.

Post Edited (Mumbo) : 10/5/2019 11:01:38 AM (GMT-6)

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