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Prostate Cancer 101

Understanding My Pathology Report

If you have been diagnosed with prostate cancer it is important to understand as much as you can about your condition. Because every prostate cancer is different, knowledge about the underlying biology of your tumor may help personalize your treatment plan. Your physician will perform several tests on your tumor tissue to provide specific information about your cancer.

Information in Your Pathology Report

Pathology ReportYour pathology report is one of the resources containing information about your tumor. This report will help guide your healthcare team in recommending an appropriate plan for you. Ask your doctor if there are additional tests you should consider to ensure you have the most complete understanding of your cancer.

Gross Description Describes the color, weight and size of tissue as seen by the naked eye.
PSA level Reflects the current level of prostate specific antigen (PSA) in your blood. In general, the higher the PSA, the higher the risk of cancer progression.
Gleason Score A rating system that describes how the cancer cells look under the microscope. How the cells look is a very important predictor of how aggressive the cancer may be and very important for making management decisions.
Tumor Cell Type The type of cancer cells in the tumor. The most common type (95% of prostate cancer) is an adenocarcinoma. Other types of prostate cancer, like small cell or signet cell, are rare and infrequently seen.
Number of cores Specifies how many tissue samples, or cores, were removed during the biopsy. It is typical to report how many cores had cancer in the along with what percentage of each core included cancerous tissue.
Location of cores Identifies from which area in the prostate an individual tissue core was taken: apex (part of the prostate furthest from the bladder), mid-zone (middle), or base (part of the prostate nearest the bladder).
Lymphovascular/ Perineural Invasion Specifies whether or not there are tumor cells near blood vessels or nerves, respectively.
Prostate Intraepithelial Neoplasia (PIN) or Atypical Small Acinar Proliferation (ASAP) These findings indicate abnormal cells that are not clearly cancerous. Although they are not cancer, some doctors will recommend a repeat biopsy if either of these are found.

Gleason Score

Prostate cancer cells do not all look alike under the microscope; some features are linked to the aggressiveness (i.e. likelihood to spread or progress) of a cancer. The Gleason Grade is a rating system that describes the aggressiveness of prostate cancer based on the appearance of the cells. The pathologist examines the most common cancer cell type (primary pattern) and the second most common cancer cell type (secondary pattern) and each is given a grade ranging from 1 to 5, with higher grades indicating a more aggressive cancer. In some cancers where all the cells have a similar appearance, the Gleason grade may be the same for both primary and secondary.

These two grades are combined to create the Gleason Score, with the primary number reported first and the secondary number reported second (e.g. 3+3=6). A Gleason score can theoretically range from 2 to 10; however, a score of 5 or lower is rare so a Gleason score 3+3=6 cancer is generally the lowest grade of prostate cancer diagnosed.

Gleason Score Aggressiveness
6 or less Low aggressiveness, likely to grow slowly and unlikely to spread
7 Moderately aggressive, likely to grow but may spread slowly
8-10 Highly aggressive, likely to grow fast and spread

Some pathologists have started reporting on tertiary Gleason patterns when a very small number of cancer cells that appear different from the primary and secondary patterns. Not all pathologists use this additional classification but some experts believe it helps to inform management decisions.

Stage What It Means
Clinical Stage T1a-b Cancer is diagnosed in prostate tissue removed during Transurethral Resection of the Prostate (TURP), a procedure for prostate enlargement.
Clinical Stage T1c Cancer is diagnosed based on a biopsy performed due to elevated PSA in the absence of any abnormality of the prostate on DRE.
Clinical Stage T2 The cancer is detected on DRE but appears to be confined to the prostate.
  • T2a involves less than one half of one side of the prostate
  • T2binvolves more than one half of one side of the prostate
  • T2c involves both sides of the prostate
Clinical Stage T3 The cancer is detected on DRE and appears to extend beyond the prostate, including into the seminal vesicles. T3a extends outside the prostate and T3b extends into the seminal vesicles.
Clinical Stage T4 The cancer is detected on DRE and has invaded adjacent organs (e.g. bladder, rectum, pelvic wall).

Understanding Your Individual Diagnosis

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Understanding Your Individual Diagnosis

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