which gleason score is more accurate - Biopsy or Path ?

I had biopsy and RALP done at two different places.

Biopsy determined that I have G7 (4+3) - 80%, 60% and 40% of 3 cores from the Right Base

MRI determined that I have ECE so I guess I was at least PT3A

But after Post RALP path report says I am G7(3+4) and PT2C and -ve margins with pereneural invasion

which of these is more accurate - esp for inputs to the nomogram as these are pretty key inputs

Thanks!

Not only is pathology the gold standard for both Gleason score and staging, MRIs are not very good at staging. They've eliminated it for staging in the new staging manual.

ddyss,

Yeah, it has always puzzled me that my MRI, biopsy and path diverged so much. The path was done in a different state than the biopsy, and a second path by Epstein himself closely matched the original path. Epstein added info that the surgical margin was right lateral, 3 mm long, focally involved with cancer of gleason 3 + 3 = 6.

An MRI done before biopsy stated, "the lesion does alter the contour of the prostate, and extracapsular disease is possible". This, btw, was what shifted me into panic mode on dealing with the situation quickly. But both paths showed "no extraprostatic extension of carcinoma". My surgeon told me there was a large varicose vein sitting next to prostate, that he just cauterized off. I think this may have been the false "extraprostatic extension" in the MRI.

My biop showed pT2a, with no left side cancer, but path did show minimal left side prostate PCa, so Epstein scored me at pT2c.

My path estimated 30% of prostate was cancer. But you would not know it from my biop 12 cores info, which follows -- remember that six of the cores going through left prostate found nothing:

primary gleason = 3
secondary gleason = 4

# cores pos = 4
# total cores = 12

total linear dimension of carcinoma = 2.5 mm
total length of all cores = 97 mm

percentage involvement of all cores = 3 %

percentage involvement of core with greatest amt of tumor = 13 %

perineural invasion = none (note: path did show PNI)

AJCC/UICC stage pT2a: unilateral, 1/2 of one side or less


Yet I had 30 % of prostate as cancer???? Wonders never cease...

Robert

Thank you all for the insight! I am definitely happy about the path. Now the wait is on for the PSA in a few months.