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Gleason grade downgrade.

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User
Posted 20 Dec 2022 at 16:21

Hi everyone, I am wondering if anyone has come across the Gleason grade going down from biopsy to histology post prostatectomy.

My history was Psa 5 post surgery. Biopsy of Gleason 4+3=7.

Post surgery histology Gleason 6 positive margin. No lymph nodes or bladder neck intrusion.  Psa <0.1

That is all I received regarding histology results so I don’t know if the Gleason 6 was at the positive margin or the whole prostrate, I didn’t think your Gleason could downgrade.

I have rang my specialist nurse to see if I could have my full histology result but she didn’t think I could get it.

Thanks in advance any  advice is appreciated.

Jeff.

 

User
Posted 20 Dec 2022 at 19:07

Not too sure if that just refers to the positive margin. I guess if there is no full stop between the two it does.

It is possible for a Gleason score to be reclassified. If you look on the internet at microscope slides of prostate cancer. You can see that the Gleason grade is a matter of opinion so two pathologists might have a slight difference in interpreting G3 and 4. Especially if it looked more 3.5 than anything else.

If it was the same pathologist then it shouldn't change.

Dave

User
Posted 20 Dec 2022 at 20:02

Jeff, you should be able to get your biopsy and prostate histology reports, I asked my consultant to send me copies of anything he sent to my GP.

As already mentioned the grading is done by a human although in the future I suspect artificial intelligence will no doubt be used.

Is there a typo in your second paragraph, did you mean PSA 5 pre surgery.

Hope your recovery goes well

Thanks Chris 

Added

Old Barry's reply got me curious about histology procedures. This led me to a couple of links. The first is a video of a histology preparation, it is a USA procedure. I never imagined my prostate looked like that. The second is a technical discussion on histology procedures.

 

https://youtu.be/QYKF5pum3Uk 

 

https://onlinelibrary.wiley.com/doi/full/10.1002/pros.23782

 

Edited by member 20 Dec 2022 at 22:49  | Reason: Not specified

User
Posted 20 Dec 2022 at 20:30
Don't forget that at Biopsy only samples are taken from various parts and the Gleason arrived at on the basis of this. With the removed Prostrate in the lab, wider examination may show more accurately the actual case.

The several Biopsies I have had always led to a 3+4 Gleason on each occasion until last year when this changed to 4+3. Maybe previous treatment had removed much of the lower grade part or the new cancer was more advanced.

If you search you will find that where sliced Prostates are different for Gleason than assessed at Biopsy, more are upgraded than downgraded quite substantially.

Barry
User
Posted 21 Dec 2022 at 10:34
It's just an opinion at the end of the day. Also a needle biopsy is a lot more destructive than slicing a whole prostate.

My G6 was also a T3a which if you believe the internet is impossible but talking to my surgeon and oncologist is not that unusual.

User
Posted 21 Dec 2022 at 12:36

Originally Posted by: Online Community Member

Thanks for the reply Barry.

Yes, I realise they would have got a clearer result on the full prostrate pathology, but what I was curious about was it dropping from a 4 on biopsy to a 3 on the final histology. I would have thought if there was some 4s on biopsy they would still be there on histology.

 Thanks Jeff 

Having a final G score of 3+3 doesn't mean that there was no 4s. The first number in your Gleason score is the most common pattern and the second number is the second most common pattern. So in your biopsy cores, most of the cells were a 3 but the next most common cells were a 4 .... once they had your prostate in a laboratory, they found that there were far more 3s than anything else and the 4s were just a minority. 

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

User
Posted 21 Dec 2022 at 15:43

Thanks for the reply Chris.

I agree with you on the points we can’t do nothing about it, I just wanted a bit more information on the basics I have at the moment.

I did speak briefly over the telephone with my nurse regarding the basic information I had been given & she spoke about no bladder neck, lymph nodes, or seminal vesicles spread & the area of the positive margins.

I couldn’t take all that in over the telephone so It would be nice to digest it better in writing.

I may not be able to take in all the medical terms but I’m sure I will be better informed.

 Thanks Jeff.

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User
Posted 20 Dec 2022 at 19:07

Not too sure if that just refers to the positive margin. I guess if there is no full stop between the two it does.

It is possible for a Gleason score to be reclassified. If you look on the internet at microscope slides of prostate cancer. You can see that the Gleason grade is a matter of opinion so two pathologists might have a slight difference in interpreting G3 and 4. Especially if it looked more 3.5 than anything else.

If it was the same pathologist then it shouldn't change.

Dave

User
Posted 20 Dec 2022 at 20:02

Jeff, you should be able to get your biopsy and prostate histology reports, I asked my consultant to send me copies of anything he sent to my GP.

As already mentioned the grading is done by a human although in the future I suspect artificial intelligence will no doubt be used.

Is there a typo in your second paragraph, did you mean PSA 5 pre surgery.

Hope your recovery goes well

Thanks Chris 

Added

Old Barry's reply got me curious about histology procedures. This led me to a couple of links. The first is a video of a histology preparation, it is a USA procedure. I never imagined my prostate looked like that. The second is a technical discussion on histology procedures.

 

https://youtu.be/QYKF5pum3Uk 

 

https://onlinelibrary.wiley.com/doi/full/10.1002/pros.23782

 

Edited by member 20 Dec 2022 at 22:49  | Reason: Not specified

User
Posted 20 Dec 2022 at 20:30
Don't forget that at Biopsy only samples are taken from various parts and the Gleason arrived at on the basis of this. With the removed Prostrate in the lab, wider examination may show more accurately the actual case.

The several Biopsies I have had always led to a 3+4 Gleason on each occasion until last year when this changed to 4+3. Maybe previous treatment had removed much of the lower grade part or the new cancer was more advanced.

If you search you will find that where sliced Prostates are different for Gleason than assessed at Biopsy, more are upgraded than downgraded quite substantially.

Barry
User
Posted 20 Dec 2022 at 23:55
Wow amazing video, I thought it would be a floppy bag!

Always wondered what the secret ingredient in a Thai green curry was!

User
Posted 21 Dec 2022 at 02:19
User
Posted 21 Dec 2022 at 06:32

Thanks for the reply Chris.

Yes my Psa was 5 pre surgery, the histology results were basically a letter confirming my 6 week post telephone conversation with the consultant.

It read: Final histology: Gleason 6 pT3a, positive margins. Post operative PSA less than 0.1 

Thanks Jeff.

User
Posted 21 Dec 2022 at 06:38

Thanks for the reply Barry.

Yes, I realise they would have got a clearer result on the full prostrate pathology, but what I was curious about was it dropping from a 4 on biopsy to a 3 on the final histology. I would have thought if there was some 4s on biopsy they would still be there on histology.

 Thanks Jeff 

User
Posted 21 Dec 2022 at 10:34
It's just an opinion at the end of the day. Also a needle biopsy is a lot more destructive than slicing a whole prostate.

My G6 was also a T3a which if you believe the internet is impossible but talking to my surgeon and oncologist is not that unusual.

User
Posted 21 Dec 2022 at 11:39

Thanks for the reply Jonathan.

So I guess it’s just a matter of follow up psa tests.

All the best  Jeff.

User
Posted 21 Dec 2022 at 12:29

Two great links Chris thanks for that.

Unbelievable what the specialists in their fields do for our health & wellbeing.

 Thanks Jeff 

User
Posted 21 Dec 2022 at 12:36

Originally Posted by: Online Community Member

Thanks for the reply Barry.

Yes, I realise they would have got a clearer result on the full prostrate pathology, but what I was curious about was it dropping from a 4 on biopsy to a 3 on the final histology. I would have thought if there was some 4s on biopsy they would still be there on histology.

 Thanks Jeff 

Having a final G score of 3+3 doesn't mean that there was no 4s. The first number in your Gleason score is the most common pattern and the second number is the second most common pattern. So in your biopsy cores, most of the cells were a 3 but the next most common cells were a 4 .... once they had your prostate in a laboratory, they found that there were far more 3s than anything else and the 4s were just a minority. 

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

User
Posted 21 Dec 2022 at 12:36

Thanks for the reply Dave although it’s just a letter confirming our telephone conversation it does have a comma between it reads: Gleason 6 pT3a, positive margins.

I have just had a call from my specialist nurse & she is going to post out my full histology report.

 Thanks Jeff.

User
Posted 21 Dec 2022 at 12:43

Thanks for the reply Lyn, I was thinking  if just one 4 was found it would be Gleason 3+4=7.

I have just had a call from my specialist nurse at pinderfields hospital  & she is going to post out the full histology report, so I will probably have more information from that.

 Thanks Jeff.

 

User
Posted 21 Dec 2022 at 13:11

Jeff, perhaps when you get the reports it will make more sense. My biopsy said 4+3 tertiary 0, my histology after surgery was 4+3 tertiary 5.

So in my case the majority of cells were 4 and 3 but there were some grade five cells in there.

You could be 3+3 tertiary 4.

I like to know all the relevant information, but on the other hand I know the info won't change anything. I have a philosophy ,if you can do something about it and then get on and do it,   if you can't do anything about it, don't worry about it.

Thanks Chris 

User
Posted 21 Dec 2022 at 15:43

Thanks for the reply Chris.

I agree with you on the points we can’t do nothing about it, I just wanted a bit more information on the basics I have at the moment.

I did speak briefly over the telephone with my nurse regarding the basic information I had been given & she spoke about no bladder neck, lymph nodes, or seminal vesicles spread & the area of the positive margins.

I couldn’t take all that in over the telephone so It would be nice to digest it better in writing.

I may not be able to take in all the medical terms but I’m sure I will be better informed.

 Thanks Jeff.

 
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