What Do You Do When Your 2nd Opinion Is Different From Your First

Sw1218

i have a question i'd like to ask. what do you do when your second opinion is different from your first. i sent in a request for my pathology report to john epstein at john hopkins. today i received the results and here's what was written:

A. benign fibromuscular tissue.

B. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) DISCONTINUOUSLY INVOLVING 80% OF ONE [1] CORE

C. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) INVOLVING 20% OF ONE [1] CORE

now take a look at my first report and tell me what you think.

D.O.B. | 1973

08.22.2018 | 3T MRI
08.23.2018 | 3 peripheral zone focal abnormalities, 1 PI-RADS 4 lesion and 2 with PI-RADS 3 lesions. No extraprostatic disease, pelvic lymphadenopathy, or enhancing pelvic bone lesions.

02.25.2019 | MRI/Ultrasound Fusion Targeted Biopsy
02.28.2019 | DX @45 with Gleason 4+3=7 

A. PROSTATE, LESION 1, LEFT APEX, 3:00, 3D MRI FUSION NEEDLE CORE BIOPSIES:
*BENIGN FIBROMUSCULAR TISSUE.

B. PROSTATE, LESION 2, RIGHT MID GLAND, 10:00, 3D MRI FUSION NEEDLE CORE BIOPSIES:
*PROSTATE CANCER, GLEASON SCORE 4+3=7 (GRADE 3) INVOLVING 3 OF 3 CORES (95% DISCONTINUOUS, <5%, <5%). GLEASON GRADE 4 INVOLVES 60% OF THE TUMOR. PERINEURAL INVASION IS PRESENT. CHRONIC INFLAMMATION.

C. PROSTATE, LESION 3, DIFFUSE LEFT MID GLAND, 3D MRI FUSION NEEDLE CORE BIOPSIES:
*PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7 (GRADE GROUP 2) INVOLVING LESS THAN 5% OF THE FRAGMENTED CORES. GLEASON GRADE 4 COMPONENT INVOLVES 5% OF THE TUMOR.

Max Former Hodgkins Stage 3

Similiar

SW,

The two reports match very closely.  The volume assessments are close to identical.  The main difference is that the first identifies some Gleason 4 material, while Johns Hopkins has it at a 3.   This is an interpretive judgement, varying a little.

Bottom line: you have PCa, at least low-grade, and possibly intermediate grade.  It is for you and your doctors to determine what to do next.

max

VascodaGama

A true Gleasoon 7

I agree with Max's opinion. The Gleason 6 from JH misses two cores in B (maybe they haven't been sent for analysis) but the two cores found positive, B and C, may have close interpretation at both labs, grading a 3 towards grade 4 (intermediate differentiation patterns). In my lay advice, I would take it as more aggressive than low-aggressive. It seems to be a true Gleasoon 7.

Your story is in here; https://csn.cancer.org/node/318867

Best,

VG

Georges Calvez

Gleason grading

Hi there,

Gleason grading is not an exact science.
It involves a technician looking down a microscope and counting cells and allocating them a grade.
There are rules but it is an impressionistic thing.
Imagine I gave two people the same plant and told them to count the leaves and give me a total for small medium and large leaves as well.
Their totals would be similar but I doubt that they would be exactly the same.

Best wishes,

Georges

lighterwood67

ComboGS

You may want to look at this;  The Impact of Differing Gleason Scores at Biopsy on the Odds of Upgrading:

The Gleason score (GS) is an established prostate cancer (PCa) prognostic factor. Whether the presence of differing GS’s at biopsy (e.g. 4 + 3 and 3 + 3), which we term ComboGS, improves the prognosis that would be predicted based on the highest GS (e.g.4 + 3) due to decreased upgrading is unknown. Therefore, we evaluated the odds of upgrading at radical prostectomy (RP) and the risk of prostate cancer-specific mortality (PCSM) when ComboGS was present versus absent.

Basically, in my opinion, this study is leaning to the higher GS as being correct.  Based on their case study, that after a RP and full pathology of prostate, cancer was upgraded from a 3+3=6 to a GS of 4+3=7.

I know a lot of this can be confusing.  My approach is I go in confused but come out smarter.  It is in my best interest to get as smart as I can, before any treatment begins.  Always your decision.  See what your doctors say.  Some key words Radical Prostatectomy; side effects; androgen deprivation therapy; pallative; curative; hormone therapy; radiation therapy; active surveillance;  salvage therapy; scans;  this list could go on forever.

You are doing the right things.  Keep searching.  Make the best decision that you can based on the information provided.  Keep in mind the quality of life potential issues.  I am 68 you are around 45.  To me age makes a difference in the decision process.

Good luck on your journey.