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I was curious about how much of the tissue is looked at under the microscope by the pathologists. Do they slice it and exam all of it. When I did a search I could not find very much info on what they actually do, but I did find some studies that dealt with the subject of whether it was useful to go to the extra expense and time of examining "all" of tissue or just selected segments (the usual practice). So I got the impression that they don't look at all of it based on some statistics that gave correct results for most cases. By the way, the studies that I found showed that in examining all of the tissue compared to selected segments of the tissue that there were some cases where the Gleason score was under graded. I did the search a while back and I don't have the links to the studies and I don't remember exactly what phrase I used for the google search. I will ask my doctor the next time I see him but does anyone know something about this or are there some pathologists out there that can explain how they determine what part of the tissue is examined ?
Re: how much tissue is examined in post op pathogy
Well I can't add too much but one paper I read mentioned that they looked at 14 sections on average for 5,000 cases at the Naval Medical Center, Portsmouth.
As far as upgrading or down grading goes just look at what the pathologist has to look at to decide what grade of cancer he/she is looking at. Google Gleason Score and you can find pictures of the different grades of prostate cancer cells. For some cases it will be obvious but others are bound to fall in the grey area. Are the cells really grade 3 or maybe they are close to a 4? Which is why different pathologist will sometimes give a different grade to the same sample.
I think Gleason Scores will be dropped quickly once DNA analysis can be done...looking at the shape of cancer cells can tell you how aggressive they might become but it doesn't tell you the best treatment to kill that specific type.
As to the differences between needle biopsy grades and post-surgical grades, there are many studies that demonstrate both undergrading and overgrading in the needle biopsy results. Usually these are about one third the same, one third under, one third over. And for some poor men, regrettably after surgery it is fond that the biopsy specimens were misread and thre was no tumour. Hence the recommendation to get a second opinion from Recognized Experts
