Understanding Your Pathology Report: Prostate Cancer
When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy.
What Is Prostate Cancer
Prostate cancer occurs when the cells in the prostate gland begin to grow rapidly and out of control. Usually, it starts out growing slowly and stays within the prostate.
There are 5 types of prostate cancers:
- Transitional cell carcinomas
Chances are high that when you are diagnosed with prostate cancer, it is adenocarcinoma, which starts in the gland cells.
The other 4 types of prostate cancers are less common. Like all cancers, prostate cancer is graded to determine how aggressive and rapidly it is growing. No matter the type of cancer, all patients diagnosed are staged. This means assigning a grade that defines how aggressive the cancer is. For staging prostate cancer, the Gleason Score is the method used.
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Gleason Score And The Progress After Surgery
In a recent research study, the severity of disease was assessed after surgical removal of the prostate in 1,251 prostate cancer patients of the ones who were initially classified as having a low-risk disease based on a biopsy and had gone through surgery. Of these men, 31% found to have a more severe form of prostate cancer and this was indicated by the Gleason score.
Also, to note is the necessity for careful active surveillance and assessing as the low-risk disease progresses. This category accounts for many of the men who end up dying of the disease. Men with prostate volumes in the 25th percentile were 50% more likely to be upgraded to more aggressive disease and men with smaller prostates were more likely to have a higher Gleason score after surgery.
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What Is The Gleason Grading System
Your Gleason score isn’t a separate test. It’s a number based on the results of your biopsy. You usually get it when you’re first diagnosed with prostate cancer.
The doctor uses the numbers 1 to 5 to grade the most common and second most common patterns of cells found in a tissue sample:
- Grade 1. The cells look very much like normal prostate cells.
- Grades 2-4. Cells that score lower look closest to normal and represent a less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
- Grade 5. Most cells look very different from normal.
The two grades added together are your Gleason score. Cancers will score 6 or more. A score of 7 means the cancer is intermediate, and a higher score means the cancer is more likely to grow and spread.
Your doctor will use this combined score along with the results of your PSA blood test and digital rectal exam to see how advanced your prostate cancer is. They’ll use this information to suggest the best treatment for you.
Calculating The Gleason Score
A doctor will use the results of a biopsy to calculate the Gleason score.
During a biopsy, a healthcare professional will take tissue samples from different areas of the prostate. The cancer is not always present in all parts of the prostate. For this reason, they will often collect several samples.
After examining the samples under a microscope, they will identify the two areas with the most cancer cells. They will then assign a score to each of these areas. Then, they will add these scores together to give a combined score, often referred to as the Gleason sum.
It is important to note that sometimes, a doctor will use a different method for calculating the Gleason score.
For example, when a biopsy sample has either a large number of high grade cancer cells or shows three different grades of mutation, they will modify the Gleason score to more accurately reflect how aggressive they deem the cancer to be.
A persons Gleason score can technically range from 210, but it is much more likely to range from 610. We will explain why this is in the sections below.
What Causes Death In Metastatic Prostate Cancer
Nearly 17% of men with metastatic prostate cancer die from noncancer causes such as cardiovascular and cerebrovascular disease and COPD, findings from a large retrospective study show. Approximately 1 in 6 deaths among men with metastatic prostate cancer are due to noncancer causes, according to a recent study.
Treatments May Have Side Effects
The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.
Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.
If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.
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Mri With A Tesla 30 Magnet Age Of Friend
Speak with the urologist about prescribing a Tesla 3.0 MRI . This test is very effective in indicating if there is any nodule involvement, if there is involvement in one or two lobes, will show size of prostate, any evidence of extracapular extension, will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet. In my laymans opinion it is advisable to have such a test before any surgery or another active treatment which is a localized one. If the cancer is outside the prostate these type treatments may not be a best decision for treatment since additionally treatment will still be required, and side effects of various treatments are cummulative.
The side effects of surgeries are basically greater than other active treatment types. Surgery is less successful among older men than younger so for example a doctor may perform an excellent surgery for a 50 year old, who will have no side effects and the exact same surgery for a 70 year old who will have side effects.
How old is your friend?
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What Does It Mean
A Gleason score of 6 is low grade, 7 is intermediate grade, and a score of 8 to 10 is high grade cancer.
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Its also important to know whether any cells rated at Gleason grade 5 are present, even in just a small amount, and most pathologists will report this. Having any Gleason grade 5 in your biopsy or prostate puts you at a higher risk of recurrence.
But because many prostate cancer cases are extremely slow-growing, the Gleason system didnt necessarily do a good job of communicating the risks for these cases. Patients with scores of 6 and 7 didnt have a clear picture of the nature of their particular cancer.
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What Does My Gleason Score Mean
A Gleason score predicts how fast your prostate cancer is growing. Named after Dr. Donald Gleason, the pathologist who developed this system in the 1960s, its commonly used today and is one of the most important measurements in a prostate cancer pathology report.
The Gleason score consists of two numbers called grades, which range from 1-5. Grade 1 indicates slow growth prostate cancer, and grade 5 is rapidly growing cancer. There are two numbers, known as the primary and secondary grade that are used to get the Gleason score.
The primary grade is given based on the predominant cell pattern seen in the cells of a needle core biopsy. The second number, the secondary grade, is the next most common cell pattern seen in the biopsy. These two grades are then added to get the Gleason score. The table below shows what each score indicates for the rate of cancer growth.
What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion
Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber with the prostate. When this is found on a biopsy, it means there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion does not mean that the cancer has spread, and other factors, such as the Gleason Score and amount of cancer in the cores are more important. In some cases, findings perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.
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What Does A Gleason Score Between 6 And 10 Mean
A Gleason score of 6 typically means the prostate cancer is low-grade and typically slow growing. Treatment may be delayed, but your urologist will discuss whats right for you.
Treatment for a patient with a Gleason score of 7 will be impacted by which number is first. A Gleason score of 3+4 is less aggressive than a patient whose Gleason score is 4+3. Even though they both add up to 7, treatment plans will depend on the order of the numbers added together.
A Gleason score of 8, 9 or 10 is considered high-grade and more likely to grow and spread quicker than a lower score. However, a score of 8 is slower growing than a score of 10. Patients with an 8, 9 or 10 may need to start treatment to keep the cells from growing outside the prostate or from spreading further in the body if they have already started to grow outside the prostate.
Understanding Prostate Cancer: The Gleason Scale
Knowing the numbers
If you or a loved one has been diagnosed with prostate cancer, you may already be familiar with the Gleason scale. It was developed by physician Donald Gleason in the 1960s. It provides a score that helps predict the aggressiveness of prostate cancer.
A pathologist begins by examining tissue samples from a prostate biopsy under a microscope. To determine the Gleason score, the pathologist compares the cancer tissue pattern with normal tissue.
According to the
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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What The Numbers Mean
The pathologist who examines the cellstaken during your biopsywill look at their patterning in the samples. Each area is graded on a scale of 1 to 5, and the two numbers are added together to get the Gleason score.
If a Gleason score is written in your pathology report as 3+4=7, this means most of your tumor is grade 3 and less of it is grade 4. These numbers are then added together for a total Gleason score of 7.
Grades 1 and 2 are not usually used to describe cancer these grades are for tissue that almost looks normal and isn’t considered cancerous. The lowest possible Gleason score of a cancer found in a prostate biopsy is 6cancer with the least risk of spreading quickly. The highest score is 10cancer with the most risk of being aggressive.
Because a scoring system that starts with the number 6 can be confusing, recently the Gleason Grade Grouping were introduced. This group number is based on the numbers used to create a samples Gleason score, but start with 1 instead of 6 and range from 1 to 5 .
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Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
Prostate Cancer: The Gleason Score Explained
How aggressive is my prostate cancer? Is it growing slowly or quickly?
If youve been diagnosed with prostate cancerand this year alone nearly 165,000 men nationwide will bethese may be among the first questions youll ask your doctor. And the answers will most likely take into account something called a Gleason score.
The Gleason score is a grading system used by urologists to assess a prostate cancers aggressiveness based on how cells from the tumor look under a microscope. Less-aggressive tumors are more likely to resemble healthy prostate tissue. More-aggressive tumors look less like normal tissue.
The higher the Gleason score, the more aggressive your cancer is likely to beand the greater the chance that it will spread. Doctors use the Gleason score to help choose appropriate treatments.
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Gleason Score For Grading Prostate Cancer
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.
Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
The Combined Gleason Score Or Gleason Sum
When a pathologist looks at prostate cancer specimens under the microscope and gives them a Gleason grade, he or she in fact will always try to identify two architectural patterns and assign a Gleason grade to each one. There may be a primary or most common pattern and then a secondary or second most common pattern which the pathologist will seek to describe for each specimen alternatively, there may often be only a single pure grade.
In developing his system, Dr Gleason discovered that by giving a combination of the grades of the two most common patterns he could see in any particular patients specimens, he was better able to predict the likelihood that that particular patient would do well or badly. Therefore, even though it may seem confusing, the Gleason score which a physician usually gives to a patient is actually a combination or sum of two numbers. These combined Gleason sums or scores may be determined as follows:
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Stages Of Prostate Cancer
Any T, any N, M1
Any Grade Group
The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.
Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.
While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.