What to make of 2nd. opinion Gleason Score reduction?

[Guest guest]

When I was originally diagnosed with PCA in August 2007 my Gleason Score was " 6 "

(3+3).

Based upon this result, my Clinical Staging of T1c and my PSA of 2.5 I proceeded

with " Active Surveillance " with a PSA taken every 3 months and an occassional

DRE which proved negative.

Two months ago my Urologist suggested I have another biopsy and the result of

this test (Bostwick Labs) was a Gleason Score of " 7 " (3+4). My Urologist

conceded that I might have had the Gleason " 7 " 2 years ago but that it was

" missed " at that time.

Nevertheless I had the slides sent to the office of Dr. athan Epstein at

s Hopkins University for a second opinion and I received the results a few

days ago showing a Gleason " 6 " (3+3).

Can someone explain what factors could explain this " reduction " in my Gleason

Score and moreover, would it be prudent to go back to " Active Surveilllance " as

I believe that there is a scandalous amount of overdiagnosis and overtreatment

in the Prostate Cancer field?

Any feedback will be greatly appreciated.

Thanks,

Sy

[Guest guest]

On June 8, Steve S replied to me:

> " Over-treatment " can mean that you went and had your prostate removed

> and maybe lost the ability to have an erection for 1-2 years (or more)

> when the the degree of your cancer DID NOT WARRANT IT.

I thank Steve S for the instruction, but I already knew that.

The dilemma many of us are forced to deal with as best we can is this:

*How do we know* whether tx is or is not warranted? At this stage, my

answer is that we do not know. At best we can guess and play the odds

after educating ourselves. This is not good enough, but it's all we now

have.

> That's the thing with prostate cancer...for those of us who are willnig

> to live for a brief while in the grey zone, there is such a thing as

> over-treatment.

No one I know claims that there is not.

> That being said, the decision IS up to Sy and his doctors. But he did

> raise a legitimate concern.

ANY concern posted in good faith here is legitimate, let there be no

doubt of that.

Regards,

Steve J

" When dealing with malignant conditions you do not save your weaponry

until you are surrounded by the enemy. "

-- B. Strum, MD

Medical Oncologist

PCa Specialist