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    Old 10-31-2019, 02:57 PM   #1
    ocman
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    Gleason Score reading

    Ok so, 6 of the 15 cores were positive.

    4 ea - 3+3
    2 ea - 4+3

    Since the majority of the cores were 3+3, why wouldn't this be considered 3+4 instead of 4+3?

     
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    Old 10-31-2019, 05:04 PM   #2
    clarkna
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    Re: Gleason Score reading

    Hi ocman,
    Whatever core is the highest Gleason is what they score you as.

     
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    Old 11-03-2019, 08:12 PM   #3
    ocman
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    Re: Gleason Score reading

    Right, then how do you get a 3+4=7?

     
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    Old 11-04-2019, 06:13 AM   #4
    IADT3since2000
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    Re: Gleason Score reading

    You would get a 3+4=7 (favorable risk, Gleason 7) if one biopsy core was scored that way and it was the core of most concern, in other words, no 4+3=7 (unfavorable risk, Gleason 7) or higher. It makes sense when you think about it. A 3+4=7 opens the possibility of success with active surveillance, though typically that surveillance is extra active. Was the pathology done by an expert in prostate cancer or a general pathologist? If not done by an expert, a second opinion by an expert would be a wise step. I did that, and my initial score of 3+4=7 was upgraded to a 4+3=7.

     
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    Old 11-04-2019, 01:07 PM   #5
    ocman
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    Re: Gleason Score reading

    Quote:
    Originally Posted by IADT3since2000 View Post
    Was the pathology done by an expert in prostate cancer or a general pathologist? If not done by an expert, a second opinion by an expert would be a wise step. I did that, and my initial score of 3+4=7 was upgraded to a 4+3=7.
    It was the pathologist at the same teaching hospital.

    I sent my slides to the expert pathologist in Maryland last week.

    Did you opt for a third opinion since the second opinion was quite different than the first?

    peace

     
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    Old 11-04-2019, 02:28 PM   #6
    IADT3since2000
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    Re: Gleason Score reading

    A pathologist at a teaching hospital probably is going to be at least fairly expert.

    I did not need a third opinion as the second opinion team was/is world renowned for their expertise. I believe you will get the expert look that will confirm or improve the initial scoring.

     
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    Old 11-04-2019, 03:52 PM   #7
    ocman
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    Re: Gleason Score reading

    Quote:
    Originally Posted by IADT3since2000 View Post
    A pathologist at a teaching hospital probably is going to be at least fairly expert.
    I agree 100%

    Quote:
    Originally Posted by IADT3since2000 View Post
    I did not need a third opinion as the second opinion team was/is world renowned for their expertise.
    Yes, that would make perfect sense!

     
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    Old 12-05-2019, 01:33 PM   #8
    ocman
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    Re: Gleason Score reading

    Just to update this thread:

    This was my original results.
    6 of the 15 cores were positive.

    4 ea - 3+3
    2 ea - 4+3

    Second opinion results, happy that one core was downgraded.

    4ea - 3+3
    1ea - 3+4
    1ea - 4+3

     
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    Old 12-24-2019, 02:59 PM   #9
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    Re: Gleason Score reading

    Hi OC. The cores of a biopsy are rather hit or-miss, samples very little tissue and therefore is not representative necessarily of the whole prostate , so the "overall" score is simple the score of the worst core, G7 (4+3) in your case. Also, cores vary in the percent cancer found in each.

    If you elect radiation, your biopsy G score is your working and last Gleason evaluation. After surgery, however, the entire prostate can be sampled and a more accurate Gleason score established. The first number is usually the most common overall pattern plus the second most common pattern across the whole prostate, along with an estimate of the percent involvement of the cancer.

    A biopsy G score can thus remain the same, be downgraded, or be upgraded.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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    Old 12-24-2019, 03:15 PM   #10
    DjinTonic
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    Re: Gleason Score reading

    Once it's established that pattern 4 present with the 3, you can't predict what the final G score will be (if you choose surgery over radiation as your treatment). Each biopsy core has a certain percentage cancer also, but this can depend on the orientation of the biopsy needle with respect to the core. A biopsy sample a tiny percentage of prostate tissue, and is not necessarily representative of what's happening throughout.

    Generally the result will be either a (3+4) or (4+3). In some cases, a small amount of pattern 5 is found (but less than the second-most common pattern). This is indicated with a "tertiary pattern 5" tacked on to one of the two scores.

    In my case there were 2 positive cores: a G (5+5) that was 50% cancer and a G (4+5) that was 3% cancer. My post-RP path stating was G (4+5) with 5% of the prostate involved by the cancer.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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