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Gleason primary and secondary switched around

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Posted 10/10/2012 2:26 AM (GMT 0)
How concerning is it that my husband's Gleason 7 went from a 3+4 on biospy to a 4+3 on post-op pathology?  The surgeon stated he felt it was not significant. 

Thanks, all.

 

Posted 10/10/2012 3:45 AM (GMT 0)
It is important. Best way to sort this out is with a reading by a new new pathologist. Bb
NBest wishes.
Posted 10/10/2012 3:46 AM (GMT 0)
Your Surgeon is not on his own.

Dr Morton from the "Prostate Net'

"While we are certain that Gleason score 7 tumors behave in a more aggressive fashion than do Gleason 5 and 6 tumors, it is less clear whether or not it makes a difference if the primary or secondary pattern accounts for the Gleason 4 grade. Some studies have shown Gleason 4+3 to be a worse prognostic sign than is Gleason 3+4. However, this has not always been the case and there are studies that find no difference between the two scores. There has not been a prospective study that has attempted to answer this question and it remains a controversial point."
Posted 10/10/2012 5:21 AM (GMT 0)
I would feel better if it stayed a "soft 7" rather than going to "hard" 7. but thats me. Who knows. I have stopped , awhile ago, trying to micromanage a fait accompli. Dr mortons statement above seems to me to fit just about every aspect of this disease. Just change the focus of the question and the statement arguably still makes sense.
Posted 10/10/2012 6:05 AM (GMT 0)
If it walks like a duck, quacks like a duck, looks like a duck, it must be a duck!
Posted 10/10/2012 6:31 AM (GMT 0)
The highly-regarded nomograms at Memorial Sloan Kettering Cancer Center do put a lot of weight on the difference between 3+4 vs. 4+3. To get even more nuanced, the question is how much of the cancer is greater than Gleason 3. So take two extreme cases, a G7 that is 3+4 with 90% G3 cells and only 10% G4 is much less concerning than a G7 case that is the other way around.

The difference would make you lean in the direction of a more aggressive treatment in certain circumstances. If there were a small positive margin or EPE and they were on the fence whether to do adjuvant radiation or wait and see if it's needed, the difference between 4+3 vs. 3+4 might be enough to push him in the more aggressive direction. But if they were already going to do adjuvant for other reasons, then the 3+4 vs. 4+3 might not make any difference.
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