A very strange confusing biopsy report

[hrdc69]

I had a biopsy a few weeks ago with a very perplexing pathology report as all my Gleason scores improved from 3+4 to 3+3 which was not what I was expecting. I had a biopsy done in January 2022 with seven samples showing cancer, four of which were 3+4 and the others 3+3. Nine template samples were benign. Total amount of cancer in those seven samples was 35mm. One target lesion was 3+4 the other 3+3.

However in the January 30, 2023 biopsy only four samples showed cancer all 3+3 and the total amount of cancer in those samples was 15mm. The two targets or ROI’s were both 3+3 and out of eleven cores taken from the two targets only 3 showed cancer. Eleven template targets were benign. This decrease in the amount of cancer and the absence of 3+4 readings is perplexing, especially considering my last MRI had an overall suspicion of PI-RADS category 5. .I realize MRI findings are only suspicions of cancer and a biopsy trumps MRI findings, but it still seems odd the amount of cancer has decreased and all the Gleason scores improved.

The biopsy was done at Weill Cornell by one of the top urologists taking 20+ cores fusing my latest MRI and GSMA Pet scan so everything was done correctly. The pathologist who did the report did a fellowship at John Hopkins with Dr. Epstein for several years and is now training pathologists at Cornell, so the pathology readings are as accurate as possible. Any thoughts on why things changed so much or is something like this a fairly common occurrence?

If someone wants to read my MRI and biopsy reports I have uploaded them to my website in PDF format. The MRI report from Nov 30, 2022 is first, then my biopsy report from Jan 7, 2022 and last is the biopsy report from Jan 30, 2023. The URL is ibmva.com/labs.pdf

[Tall_Allen]

Take the win! You can get a Decipher report to give you more assurance. Needle biopsies are just samples, and the angle at which they go into tumors will affect the Gleason score, the amount of cancer, and the percent of each pattern.

[hrdc69 in reply to Tall_Allen]

Thanks for the reply TA, and I would like to think the needles were put in at the correct angle as the doctor is dual boarded in both IR and urology and has an excellent reputation. It's just hard to understand how all four samples from last year that were 3+4 now are 3+3. I can understand one or two samples doing that but all four and then less cancer overall to boot! Prior to the biopsy my RO had advised at least 4-6 months of ADT with a possibly longer course if the biopsy came back worse than 3+4. Yes, I will take the win but still plan to do SBRT but no ADT unless I want to be super safe.

[Tall_Allen in reply to hrdc69]

There is no "correct" angle, there is just the way he inserted the needles.

[cesanon]

The Gleason Score readings are just not that precise to begin with.

I second what Tall Allen says.... take the win