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Before the advent of the PSA (Prostate Specific Antigen) which serves a screening tool for prostate cancer, the diagnosis for prostate cancer was through a rectal exam. Sometimes, a rectal exam will often show an enlarged prostate with a hard, irregular surface when patients have prostate cancer. Depending on your age and previous PSA results, you will have to undergo a prostate biopsy to determine whether or not you have cancer.
A prostate biopsy is usually done in the urologist’s office using a rectal ultrasound probe. Samples of the prostate are taken through the probe and sent to the pathologist for review. If the results return positive for cancer, the tumor samples will be graded using a grading system called the Gleason Grading System.
The Gleason grading system accounts for the five distinct patterns that prostate tumor cells tend to go through as they change from normal cells to tumor cells.
The cells are scored on a scale from 1 to 5:
“Low-grade” tumor cells (those closest to 1) tend to look very similar to normal cells.
“High-grade” tumor cells (closest to 5) have mutated so much that they often barely resemble the normal cells.
The pathologist looking at the biopsy sample assigns one Gleason grade to the most similar pattern in your biopsy and a second Gleason grade to the second most similar pattern. The two grades added together determine your Gleason score (between 2 and 10).
Generally speaking, cancers with lower Gleason scores (2 - 4) tend to be less aggressive, while cancers with higher Gleason scores (7 – 10) tend to be more aggressive.
It’s also important to know if any Gleason 5 is present, and most pathologists will report this. Having any Gleason 5 in your biopsy or prostate puts you at a higher risk of recurrence.
Based on your PSA and biopsy results, additional testing may be done to determine the extent of the disease before making a decision for treatment. These tests include:
• CT scan
• Bone scan
• Chest x-ray
