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Gleason score 3+4=7

User
Posted 10 Jun 2023 at 09:50
Fred, your PSA is fine - the actual reading in February could have been 0.0094 and in June 0.0095. These tiny changes could simply be machine noise, or just different times of the day. PSA can be slightly higher first thing in the morning, for example. At the moment, your PSA is about the same as a woman who is breastfeeding - small amounts of PSA are produced in other parts of the body.

Free PSA is not relevant to a man who has had his prostate removed. It is a test that helps doctors predict whether a man might have prostate cancer when his PSA is between 4-10 and whether or not to do a biopsy

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

User
Posted 10 Jun 2023 at 11:20

I had my prostate removed late December 2021 and for the first 2 quarters after that Addenbrookes tested my PSA down to  0.04. Mine was always less than 0.04. Subsequently, my further quarterly PSA tests was "only" tested down to 0.1 and mine came out then to less than 0.1. My next test in July  is my first 6 monthly PSA test and I have no doubt my PSA will only be tested down to 0.1. Addenbrookes told me that testing to less than 0.1 was causing unnecessary worry in patients as small movements under that figure were mostly meaningless. And as mentioned by Lyn, even without a prostate small amounts of PSA are produced by the body.

 

Ivan

User
Posted 09 Jul 2023 at 11:44

Hi

I wonder if I could ask a question about someone else cases that is not member of this forum member?

A friend of mine that leaves abroad had G7, T3a and done radical prostatectomy that showed that cancer have had spread outside prostate. So he had to have RT and HT but was told treatments could not start until his (high) incontinence is improved.

I wonder why he has to and how long he should wait?

Thanks  

User
Posted 09 Jul 2023 at 12:41
Because usually you need to be able to hold a full bladder during the RT zapping. Sometimes, an onco prefers to do the RT with a completely empty bladder but it isn't a common approach.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Aug 2023 at 07:21

Hi.

I was reading one of survivor stories in Yananow.org (https://www.yananow.org/display_story.php?id=387) that said "path report gave a final Gleason score of 6 as opposed to the 8 from the biopsy report".

I always thought a post operation pathology grade is either the same or higher than biopsy?

How come one have G8 from biopsy but then graded down to 6 from pathology?

 

Many advanced thanks for replies.

User
Posted 20 Aug 2023 at 09:00
Because a biopsy is a guesstimate based upon a sample. If they take 20 samples from the prostate then they calculate the 'probable' Gleason based on those samples - but they could have hit all cancer spots by chance. The only true Gleason is when the lab slices the prostate open on the bench.
User
Posted 20 Aug 2023 at 12:02

I agree with Fred, the logic says a Gleason score could never go down. To have a G7 biopsy there must have been at least one tiny bit of Gleason pattern 4 in the samples. In the path lab they can now examine all of the prostate, they 'must' see that area of pattern 4 again so it cannot go down, and if they happened to see some pattern 5 it would go up. You might say well if they spotted a lot of pattern 1 or 2 that would bring it down? No, Gleason score is about the maximum and secondary maximum in two samples it is not about averages.

So now if we follow the mathematical logic, we have to ask. Was the pattern 4 in one place and tiny, and completely removed by the biopsy needle? Extremely unlikely, about 0% chance that that is the reason. Maybe the cancer just got better? Again extremely unlikely, yes the immune system attacks cancer, but only in the early stages once it has got hold it won't die on its own, about 1% chance this is the explanation.

So our maths and logic has not given us the answer.

Now if you go on the internet and look up pictures of biopsy samples you will see how ordered Gleason patter 1 is and how disordered pattern 5 is. If you then look at more samples you can start saying what you think the pattern is, and then check with what the expert says. 80% of the time you will agree with the expert on what a pattern 2,3 or 4 looks like, but some will be marginal, maybe pattern 3 maybe pattern 4.

So I would guess that all the samples from biopsy and pathology looked about the same and it was a bit more disorders than patten 3 but not quite as bad as a typical pattern 4. One pathologist decided to call a 4 the other called a 3. Hence Gleason score 8 and 6, because of the difference in the person looking at the sample not the samples themselves.

Dave

User
Posted 20 Aug 2023 at 12:55
... and very much depends on the skill and accuracy of the surgeon performing the biopsy. The sample gun is guided by a human being even though the plot of targets is displayed on the echo screen.
User
Posted 20 Aug 2023 at 14:32

Histology on a removed prostate is still sampling that can miss something more significant. It's typically about 6 slices through the prostate so it's a bigger sample than the biopsy, but it could still miss something that a biopsy found, or indeed they could both miss something more significant.

User
Posted 20 Aug 2023 at 14:47
Where did you get that info Andy? Pathology lab procedures typically examine a minimum of 18 slices and up to 76 slices based on 3mm slicing with 4 um sectioning for examination under the microscope. Some work has been done on sampling the slices (1 in 2) in order to reduce lab workload but I don't believe that has been adopted.
User
Posted 14 Sep 2023 at 13:27

Hi,

I was going through my medical record where I noticed part of my diagnoses indicated “G7, T3a, bilateral small peripheral zones invasion”. After prostatectomy the report indicated pTC2 with "Negative Margin" and stating that the local excision was complete.

The current convention is to categorize a margin as negative if tumor cells are not at the inked margin, even if they are within a few cells of the margin.

Q: Considering that T3a downgraded to T2c with negative margin means diagnoses “bilateral small peripheral zones” was not true prior to operation, there was no invasion of peripheral zones?

User
Posted 14 Sep 2023 at 14:01
Hi Fred

It would seem that the biopsy cores were not examined to the extent that the lab did to the removed prostate which would make some sense given that it is a sampling and not definitive.

The T2c indicates that the cancer had progressed to the gland wall but had not penetrated it - as you said, it could be a few cells away from doing so, in which case you caught it just in time :)

User
Posted 10 Nov 2023 at 19:25

My PSA, 22 months post prostatectomy is still undetectable.

I had a query and am sure there are good many members who could help and reply. I wonder how important is the post surgery pathology reports once PSA reaches 0.2 (that is when further treatment is needed) in planning future treatment plans? Or that from there onwards, further tests defines future treatments plan? 

Thank you all

User
Posted 10 Nov 2023 at 22:10

Originally Posted by: Online Community Member

My PSA, 22 months post prostatectomy is still undetectable.

Great news Fred.

I'm in a pretty similar position, but a year behind you. My three post op PSA tests have been undetectable. Let's hope that they remain that way.  I suppose if they increase above 0.2 they'll start a further treatment plan and that would involve reviewing our previous records including the histology of our removed prostates.

 
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