Bob Parsons was 51 when he was diagnosed in March 2002. His initial PSA was 46 ng/ml and his Gleason Score was 9. His journey has taken many twists and turns as he has kicked and bucked against the way some of his medical practitioners treated him and his diagnosis. Always curious about this complex disease, in early 2011 he manged to view his original pathology slides and get copies of them from a frinedly pathologist. Here he shares what he has learned.

I had a renewed interest in pathology after a PCa seminar meeting - one of those put on monthly by my local oncologist-doctor, who is just fabulous and after reading about what German pathologist Dr. Bonkhoff can do that other pathologists cannot or are not doing. My oncologist answered my wishes after I told him I had read read a seminar Journal article by Dr. Bonkhoff which led to Dr Strum sending me a copy of a joint paper [this is a large 3MB+ file] that he and Dr Bonkhoff had written - and had given me permission to publish that. Dr Strum was also kind enough to give me an indication of how the enhanced pathology reports issued by Dr Bonkhoff are interpreted. Here is what the summary looks like for a typical patient:

Using this kind of analysis, it is possible to see what gene or enzyme is over expressed or under expressed and make recommendations. For example,

If there were an over-expression (oE) of FAS (fatty acid synthase) then it might be suggested that agents that can dR (down-regulate) FAS might be: Xenical (orlistat), EGCG, 1,25 DHCC (Calcitriol), parasitic loranthus, GLA >alpha linolenic acid > DHA;

On the other hand, if there were under-expression (uE) of p27, then: DHA, Silibinin, beta-lapachone, calcitriol, magnolol (Honokiol), might be advised.

There is a signficant problem in finding a local doctor who can actually interprete and apply those details. Most men are fortunate if they can find a local urologist who just keeps current on contents in one or two journals and is open minded enough to honestly represent the several major treatment options. It is a sad commentary on the urological community that this is so much of a challenge.

I mentioned to my oncologist my objective of seeing my pathology slides, kept in storage at Detroit Medical Center Hospital pathology laboratory and learning more. He made it happen with a local hospital pathologist, a guy with 22 years experience at pathology. He knew about Dr. Bostwick and some other renowned America pathologists but had not come across Dr Boonkhoff and his work, so he had not seen the Journal article. He did this for free as a favor to my oncologist-doctor and he did for me, shows there are stand up people who give a darn.

I had 12 biopsy shots. This gives six slides, some slides have four samples upon them, your samples are often split, or cut somehow, down the middle and shown as two sets (4) total to analyze. Regular chemistry slides are used, but also a cover plastic sheet on top, to prevent scratching and docs says for better imagining use.

The Gleason Grading criteria changed in January 2011 and lowest graded known PCa is now listed as Gleason Grade 3 using the normal combined grading system for samples from needle biopsy procedures, thus Gleason 6 combined score is the lowest (3+3)=6. No longer do we see or use Gleason combined scorings of 4, 5 or less (2+1)=3 and such are defunct [See Gleason Grades for more information].

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This first photo is combined Gleasons scores 9 (seen with photo is Gleason grade 5 and maybe 4's also) On my patho report A. and B. were Gleason 9's. See the density of the red and dark red PCa cells, this is called cribiform pattern...mostly consistent with Gleason grade 5 level.

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Second photo is likely my Gleason 7 graded samples, seeing large open tubular gland cells (this more towards normal with open cells like this)

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Third photo is more consistent with Gleason grade 4 patterns, and comibined my scores were in one sample (4+4)= Gleason 8 and another sample (3+5)= Gleason 8 The first number in a combined Gleason scored is the more predominate graded PCa and then follow by any secondary less volume percentage grade found.

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Fourth photo is enlargement atleast 100X or more, the cells towards the center are curvey- squiggly like in appearance...this is PNI (pernueral invasion) it is surrounded by the red looking PCa cells...thus the possibility of invasion into the blood system, through this blood vessel/nerve. In PCa having PNI found on biopsies does not mean it happened to travel, it is a prognositic risk factor and noted. People have been cured of PCa and have even various samples found with PNI upon biopsies

Some of the other articles and papers I have read lately that deal with these pathological issues are:

Targeted therapy of cancer: new roles for pathologists—prostate cancer Mark A Rubin

A Proposal on the Identification, Histologic Reporting, and Implications of Intraductal Prostatic Carcinoman [This is a large - 3MB+ pdf file] Ronald J. Cohen, MBBCH, FFPATH, FRCPA, PhD; Thomas M. Wheeler, MD; Helmut Bonkhoff, MD; Mark A. Rubin,