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]

Steve J,

" 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.

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.

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

legitimate concern.

Steve S

>

> (snip)

>

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

> > Gleason Score

>

> Gleason scores are determined by pathologists who examine the specimens

> microscopically.

>

> It is not unusual for variations between different opinions to appear.

> And that's what they are: opinions.

>

> Oppenheimer and Gleason are both highly recommended pathologists.

>

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

>

> I hope that there is no one here so foolish as to try to give Sy

> treatment advice. That is his choice alone, with advice from (a)

> competent medics and ( from his own study.

>

> Regarding study, I recommend this piece by Mark Scholz, a well-respected

> PCa specialist: " The Way to Find the Best Available Treatment for Your

> PC. Advice For Men Newly Diagnosed with Prostate Cancer. "

>

http://www.prostate-cancer.org/education/riskases/Scholz_FindingBestTreatment.ht\

ml

>

> > as I believe that there is a scandalous amount of overdiagnosis and

overtreatment in the Prostate Cancer field?

>

<b>> Maybe there is and maybe there isn't, but is Sy willing to bet his life

that treating HIM would be wasted motion?</b>

>

> So here's my usual advice: Study, Learn, Take Charge.

>

> Regards,

>

> Steve J

>

> " Empowerment: taking responsibility for and authority over one's own

> outcomes based on education and knowledge of the consequences and

> contingencies involved in one's own decisions. This focus provides the

> uplifting energy that can sustain in the face of crisis. "

> --Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled

> " The Empowered Patient's Guide. "

>

[Guest guest]

Sy,

You ask two questions:

1. Can someone explain what factors could

explain this " reduction " in my Gleason Score……..

AND

2……… 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?

To try to answer these:

1. The interpretation of Gleason Grades is

entirely subjective and therefore there can be significant differences of

opinions between experts on the actual grading. I have suggested previously

that you read the story on my site where Millar tells how no less than

five pathologist reports and two biopsies failed to resolve the question as to

whether he had prostate cancer or not – that is at http://www.yananow.net/Mentors/M2.htm

and it is well worth reading to gain an understanding on this subject. There

are other experiences with similar outcomes.

2. If you considered that Active

Surveillance was an appropriate option for you previously, why do you think it

is not appropriate now? After all, there are studies where men with GS 7

diagnoses are included.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of sytech

Sent: Tuesday, 9 June 2009 4:07 AM

To: ProstateCancerSupport

Subject:

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

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