Dear OncoLink "Ask The Experts,"
I am writing to you from Italy. A member of my family, a 62-year-old man, was diagnosed with prostate cancer. The biopsy showed Gleason score 1 + 2 and he was told to have radiation, due to his age. We consulted other experts, some recommended radiation therapy, the others even told him not to "wait and see". Eventually, we had the same biopsy results sent to one of the leading specialists. His re-examination showed instead that Gleason score was 3+2. At this point, he's completely confused. How can the same biopsy differ in Gleason score?
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
There are a couple possibilities; the first is that one of the pathologists was using the Mostafi system since a grade 1 to 2 Mostofi tumor corresponds to a Gleason 5 or 6. The second is that yes, in 7% of reviews, the Gleason may increase by more than 1. I would use the Gleason of the senior pathologist and base the recommendation on that evaluation. Treatment selection would still depend on other conditions, particularly the quality of surgery and radiation in the community where the individual lives. For patients who elect to "watch and wait" instead of having treatment for their cancer there is an anticipated 10% to 12% annual risk of metastases and a mortality rate of 5% at 5 years, 20% at 10 years and 60% at 15 years.