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New to this forum!!

User

Posted 15 Dec 2020 at 16:48

Hi there

My 63 year old husband was diagnosed with prostate cancer 3 years ago with a rising PSA (5.8 to 7.3) and a Gleason score of 3+3 from a transperineal biopsy. His consultant was pragmatic and suggested with these scores, he should be put on a surveillance programme rather than any formal treatment.

We subsequently moved to Norfolk 2 years ago (from Bedfordshire) and Norfolk have said their policy is to carry out biopsies every 2 years (Bedford consultant said every 4-5 years...) so he very reluctantly had one 2 weeks ago. Norfolk Urologist (Nurse) says his score is now 3+4, they took 30 samples but only found 2 to be of any real concern/cancerous.

He's upset. We don't understand the scoring. He was hoping for a 3+3 again but we are not sure whether the two biopsies have actually been compared - the Urology nurse said she hadn't seen the first biopsy results. This may be a stupid question but could it be down to Bedford interpreting the biopsy differently to Norfolk or is this something which is set in stone, it can't ever differ from one area of the country to the other? He is scheduled for a telephone call with the consultant in March so we feel they can't be overly concerned but that's a long time for him to worry.

You are the experts out there - would love to hear your views...

User

Posted 15 Dec 2020 at 17:32

Hi Lucy

I have just went and had a look at my husband’s biopsy report and at the bottom it's shows that two Pathologists signed the final report. Again on his post op histology report it mentions three pathologists names.

My interpretation of this is that they agree and come to the same conclusion. So first time for your husband they agreed G6 and now they agree G7.

Could it be that there are so few grade 4 cores and they weren’t picked up last time?

I wish you both well and be assured you will got lots of expert advice on here, it’s been my lifeline for 9 months.

Edited by member 15 Dec 2020 at 19:13 | Reason: To add extra sentence

User

Posted 15 Dec 2020 at 18:14

Hi Lucy,

Welcome.

May I suggest phoning for an information pack if you haven't already and you and husband digest.

Please see.

https://prostatecanceruk.org/prostate-information/our-publications/publications/tool-kit

Active surveillance needs clearly understood and implemented, and you both need to understand all the options and risks, in my humble opinion.

Hope this helps, I'm sure others will soon reply.

Regards Gordon

Edited by member 15 Dec 2020 at 18:16 | Reason: Not specified

User

Posted 15 Dec 2020 at 19:00

It is down to the interpretation of the individual pathologists and the urologist & oncologist also have a look at the images. The pattern (a 3 or a 4 or a 5) is describing how far from 'normal' the cells look - a 3 means that the cells look fairly normal. The official language is how 'well differentiated' they are so different people will look at a slide of cells and have slightly different views about whether it is a 3 or a 4. Regardless of that, it seems that he only has a very small amount of cancerous cells in his prostate so the fact that the secondary pattern might be a 4 rather than a 3 may make no difference to the decision to continue on AS.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 15 Dec 2020 at 19:32

A biopsy by its very nature is a "hit and miss" sampling process. The difference in scores probably simply means that there's only a small number of cells of grade 4 and the second biopsy samples some but the first didn't. Prostate cancer doesn't get more aggressive with time: grade 3 cells don't turn into grade 4.

It sounds as if your husband's cancer is not very widespread, so don't get two stressed about it (easier said than done, I know).

Best wishes,

Chris

User

Posted 15 Dec 2020 at 20:12

I agree with Lyn and would just add the following as you are new and maybe not familiar with the Gleason Scoring system. The first figure given is the one for the majority of cancer cells and the second figure the assessment of the less numerous. Therefore a 3+4 contains a lesser number of cancer cells that are further from normal than a 4+3.

The volume and position of cancerous cells is also important because the situation becomes more serious where these form a bulge and start to break out. MRI's are often used to chart advance but sometimes biopsy also or alternatively. The great thing with an MRI scan is that you don't risk the infection that you can sometimes experience with a biopsy, although the latter is more likely to show cancer cells that can't be seen in MRI.

As regards follow up, it sometimes depends on your area. This is not only the case for PCa. I had some early skin cancer removed in the Greater London area and was told I would be examined yearly for 5 years. However, after 3 years I moved to Devon and when my GP at my request referred me for examination for my forth check up, I was told I would have only been followed for 2 (or could have been 3) years in Devon.

Barry

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