John Hopkin's biospy report

CF, the general opinion on this forum is that JH is THE gold standard for prostate biopsy reporting. In reality, the treatment difference between 4+3 and 4+4 isn't significant. You have a slight downgrade, but not enough, IMO to choose a different treatment course.

We have seen members have significantly different JH reports from their local pathologists--enough that it changes the treatment path.

What you do know, now, is that your case is confirmed, and your doctors can be assured that their treatment plans are secure and understood.

The percentages for the two Gleason patterns, 3 and 4, are that seen in the portion of the core that is cancerous. You are correct: I don't think there is much difference between the two reports.

Note that if your pattern 3 were anything from 0 to 5%, JH would still grade you G8 (4+4). When you have a pattern 4 or 5 that is less than 5% it is listed as a "tertiary 3 (or 5)"; however, a "tertiary 3" is of no importance when you primary and secondary patterns are made up of 4s and/or 5s, so you rarely see a "tertiary 3" it in a path report.. So JH's G8 (4+4) means they may also have seen pattern 3, but if present, it didn't rise to more than 5%.

For arguments sake, even if the G7 were "correct" (i.e., the pattern 3 is 10% in those cores), it is very possible that-- should you opt for surgery, when the whole prostate is examined--the amount of pattern 3 could fall below 5%, which would upgrade you (slightly) to a G8 (4+4) anyway.

If this were my biopsy, I would consider my pre-treatment Gleason score to be G8 (4+4).

Hope that helps,

Djin

Post Edited (DjinTonic) : 5/20/2022 10:30:33 AM (GMT-6)

JNF said...
My uro told me “we don’t count the 3’s. We treat based on the highest G grade”. For you, that is a 4. And since you have a lot of it in two cores, take it seriously and treat like a G8 score. With at least 90% involvement in the core, the chance it has escaped the capsule may be significant. This should help h[guide your treatment considerations. Now you can run the nomograms for some more data points to consider.

Perhaps you meant "Gleason score" (the sum of your two Gleason grades). You wouldn't necessarily treat a G7(3+4) like a G8(4+4) even though they have the same highest grade (4).

With G7 (3+4 or 4+3) what counts is which pattern is >50%. And the biopsy score for a G7 is, in my opinion, often a crap shoot when the percentages are roughly equal, e.g. 60/40. That is why so many G7 men are up- or down-graded in their final path report. The calculus changes when your biopsy pattern 4 is high.

In the U.S. your biopsy score is considered to be that of your highest lesion; however, for example, a G7(4+3) is not always treated the same as a G7(3+4). A 4+3 would not be a candidate for AS; some 3+4 men are. I think a 4+3 biopsy will usually trigger a bone scan, while a 3+4 won't. ADT would be more likely to added to RT as primary treatment for a 4+3 than for a 3+4.

Djin

Post Edited (DjinTonic) : 5/20/2022 10:29:47 AM (GMT-6)

big difference between G7 and G8, imo. which watch is giving you the right time?

i would assume high risk and have a line in the sand followup plan in place. good luck man!

After my RP the hospital pathologist came back with 4+3. I sent it to John Hopkins who came back with 3+4. Then Mayo calculated it at 4+3. So there is still some subjectivity in the analysis even after surgery.