Biopsy report before surgery vs after surgery

[Dalph87]

Hi all, my father was diagnosed in April 17 with a Gleason 9 (5+4) as stated on the biopsy result.

He went for radical prostatectomy two months later, and the after surgery biopsy result stated it was actually a Gleason 7 (4+3).

My questions here are, is it possible it was really Gleason 7 and not 9? Which biopsy is more accurate? I guess the after surgery one since all the tumor tissue is taken to be analyzed and not just a small amount?

Dad is doing well currently, he had 6 rounds of Docetaxel (which he was able to tolerate) to get rid of the lymph nodes and is now on Zytiga for 3 months and a half to prevent further growth. Current PSA is around 3, been like that for over 3 months, no pain, no currently active bone or lymph mets, I guess what is left is microscopic.

Thanks in advance.

[pjoshea13]

The post-surgery pathologist's report is the most accurate, since a biopsy is only a sampling of prostatic cells. It is quite common for the Gleason score [GS] to change - mostly an upgrade but sometimes a downgrade.

This from a recent Belgium study [1]:

"38.1% were pre-operative low risk, 58.7% of them had an upgrade in GS on final pathology ...

"45.1% were in the intermediate risk group, 5.4% showed a downgrade, 64.3% remained stable and 30.2% had an upgrade in GS...

"16.8% were high risk patients of which 35.4% had a downgrade, 39.6% remained stable and 25% showed an upgrade of the GS."

I hope that one day, we will rely on panel tests using blood &/or urine, rather than crude biopsies. That could eliminate perhaps 75% of biopsies.

It would represent an income hit to doctors who argue that a biopsy is essential because it is "accurate".

A GS of 4+3 does not preclude there being some Gleason number = 5 cells - it's just that they are not the most common.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/287...

[Dalph87 in reply to pjoshea13]

So it's a Gleason 7. Thought so, thank you for your info.

[rkengen]

Why they did a radical prostectomy?

I had 6 docetaxel n have three monthly zoladex.

[Dalph87 in reply to rkengen]

The urologist thought he could get it all and although he did a good job sadly a few cells escaped the prostate, the MO also agrees with him and claims that the surgery really helped my father and that his situation would have been critical without it.

At the very least he can pee much better nowdays, no more sting, burn or sharp pain, and no more incontinence.

[j-o-h-n]

Post numbers are spot on! It's like viewing a woman with and then without makeup.

Good Luck and Good Health.

j-o-h-n Sunday 08/26/2018 9:18 PM EDT

[doc1947g]

I am surprised that he had a PSA of 3 after a RP, it should be undetectable or at most 0.01.

Maybe you meant 0.03.