Final Pathology Report Compared To La... - Advanced Prostate...

Advanced Prostate Cancer

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Final Pathology Report Compared To Last Biopsy Performed

Fox2018 profile image
20 Replies

Hello All,

For those of you who have had surgery to remove the prostate, what has been your experience when comparing your last biopsy results to the pathology report performed on the removed gland? More or less cancer found?


20 Replies
BerkshireBear profile image

Fox, over the years here and on the predecessor board I've never recalled seeing a report of less cancer than the biopsy. I guess that's pretty much an improbable. But the good thing in my recollections is that the increase is generally only slight.

Remember that the biopsy is usually only a dozen or so sample about 1/2" long taken from one side of an organ that is roughly the size of a golf ball. That's a pretty random sampling (unless it is MRI guided) so it's quite possible to miss something.

Perhaps the more important observation to gain from the post-op biopsy is whether there is evidence of the cancer at/on the surface where it might have escaped from the prostate.

pjoshea13 profile image
pjoshea13 in reply to BerkshireBear

Downgrading can occur:

"Most Gleason 8 Biopsies are Downgraded at Prostatectomy-Does 4 + 4 = 7?"

"Of 5,474 Gleason 8 biopsies in men lacking other high progression risk criteria 3,263 (60%) were downgraded, changing the progression risk category from high to intermediate. A higher prevalence of Gleason 8 downgrading was significantly and independently associated with decreasing age, African American race, lower cT category, lower prostate specific antigen quartile and certain combinations of primary and secondary Gleason grades (3 + 5 greater than 4 + 4 greater than 5 + 3)."



in reply to pjoshea13

That would be nice. I was gleason 8 in one of the five cores positive for cancer. Age 66 at time of diagnosis. PSA 2.7. Got sent for biopsy after DRE was palpable.

Tall_Allen profile image

The results aren't comparable. The biopsy just extracts a core within the tumors it happens to penetrate.

Fox2018 profile image
Fox2018 in reply to Tall_Allen

yes I understand - it just seems that accepting the biopsy results as an accurate representative of the disease in one's prostate almost always errs on the low side - this can be misleading when deciding on a future course of treatment

Tall_Allen profile image
Tall_Allen in reply to Fox2018

It's the best we have. Upgrading is seen in about a third of cases. Therapies are based on what is discovered at biopsy, so outcomes allow for undergrading and understaging.

Blackpatch profile image

Hello Fox

My G8/9 at biopsy turned into G7 (75% 4 + 20% 3) with 5% tertiary 5, so that was good...

Not so good was that SV and ECE, which were not there on 3T MRI or PSMA PET or carefully targeted biopsy shots, both turned up....

All in all, upstaging, but good news on the grade.

When you thick about the tiny fraction actually sampled, it’s surprising the correlations are as high as they usually are.


Hawk56 profile image

Biopsy was GS 9 - 4+5

Pathology report after surgery was GS 8 - 4+4

I had John Hopkins do a 2nd opinion, they confirmed the pathology report

baw1955 profile image

Just re-read my path report. Gleason 7 (3+4). Tumor was 40% of prostate; pattern 4 was 40% of the tumor. Assume that means 16% of prostate was pattern 4. My biopsy was Gleason 7 (4+3) based on the twelve core samples.

Fox2018 profile image

Thank you all for your comments - I appreciate learning from each one you!


dadzone43 profile image

In my case, there were G9 findings, an uptick from the G7&8 in the biopsy. Additionally, there was a finding of tumor cells in the margin. My urologist contends that the heat from the cautery would likely destroy those marginal cells. My PSA remains undetectable at 11 months so I am banking on his being correct.

Fox2018 profile image
Fox2018 in reply to dadzone43


Gemlin_ profile image



The Gleason score on biopsy usually reflects the cancer’s true grade. However, in about 20% of cases, the biopsy underestimates the true grade, resulting in under-grading. This can occur because randomly directed biopsy needles occasionally miss a higher grade (more aggressive) area of the cancer. Under-grading is statistically more likely to occur in men with: 1) larger tumors, 2) higher PSA levels, and 3) smaller prostates.

Somewhat less commonly, the true grade of the tumor is lower than what is seen on the biopsy, resulting in over-grading. For example, studies show that 16% of cases with a Gleason score of 3+4=7 on biopsy, will end up having Gleason score 6 when the surgically removed prostate is examined. Discrepancies between the biopsy Gleason and the final Gleason after surgery may be caused by inaccurate over-grading of the biopsy specimen by an inexperienced pathologist, or because the actual quantity of pattern 4 originally detected in the biopsy core turned out to be so small that it could not be found by the pathologist who examines the surgically removed prostate.

Fox2018 profile image

Thank you, Gremlin!


j-o-h-n profile image

Like the Northern part of the United States. .......UPPER U. S.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/07/2019 8:32 PM EST

baw1955 profile image
baw1955 in reply to j-o-h-n

j-o-h-n. Hmmm.... you replying to my Avatar? Upper Peninsula (of Michigan) = U.P. = Yoopee. I am a Yooper!

j-o-h-n profile image
j-o-h-n in reply to baw1955

Yippee Yooper..........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/23/2019 11:10 PM EST

Prostratehelp profile image

My biopsy’s showed minor cancer cells. First biopsy was 12 cores showed 3 with less than 10% cancer cells. Second biopsy was 24 cores with same result. Gleason score of 3+3.

Pathology report after surgery showed cancer was much worse and had spread beyond the prostate. Gleason score of 4+3.

Dr. Partin at John Hopkins studies showed that of those who “elected” surgery, 70% showed much worse cancer than their biopsy’s had shown.

StevieR profile image

Mine, pre-surgery was Gleason 8 in one spot (out of 12, one year after Gleason 6 in one spot out of 12, then not discernible on MRI), with scans showing potential seminal vesicle invasion on one side. Pathology after RARP was Gleason 9, with seminal invasion on both sides, extracapsular extension and positive margins. By the way, PSA was never above 4.2 and was 3.6 before surgery, surgeon was surprised/dismayed by outcome, although PSA was <0.1 after surgery. I began Lupron three weeks after surgery and had two months of adjuvant RT, hopefully took out most of the stray cancer cells, time will tell. All the best to you.

Fox2018 profile image

Hi -

Went for 6 week post surgery PSA blood test today. Will get result early next week. Nervous...!

Thanks for your response.

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