If your doctor notices your PSA levels are continuing to rise, or the digital exam causes concern, further testing may be recommended. There may be other tests to rule out non-cancerous conditions such as a urine test to check for blood or infection. Additionally the doctor would like to look at the prostate and potentially examine the cells within the prostate. This is done with:

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Transrectal Ultrasound

The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.

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Transrectal Biopsy

A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

Understanding the Results of Your Prostate Biopsy

Rear view of male doctor talking with senior patientThe tissue removed during a prostate biopsy is sent to a pathologist for further analysis and testing. Pathologists are doctors who perform various tests on the tissue to see if the cells are cancerous, precancerous, or normal. Your pathologist will then summarize the results of the tests and their findings in a prostate biopsy pathology report that details the results and outlines the findings. This report is a critical part of determining a treatment plan for each patient.

The report discusses any abnormal, atypical, or cancerous cells that were found. Pathology reports can differ on some of the specific information they contain based on each pathologist. Still, there are a few key components that you may want to review.

  • Gross Description - this is the pathologist’s initial study of the tissues without using a microscope.

  • Microscopic Description - this portion of the report is also a visual study of the tissue. This section covers what the pathologist saw when the tissue was under magnification.

  • Gleason Score - this section outlines a specific method of understanding how fast cancer may grow. That results in a grade.

  • Cell structure - your pathologist will also classify cancer based on the cell structure. This section is typically broken into three grades and identifies how well cancer cells are differentiated from each other. This can result in determining the type of prostate cancer that’s present.

While it is likely that your medical team will have copies of your report, you should request your own. Take your time in reviewing the report and ask questions about parts that are not clear.

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If Prostate Cancer is Found

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.

Gleason Score

One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most normal cell pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 3+3=6. 

Gleason scores under 6 often don't require treatment right away. If the predominant cell pattern is a 3 and the secondary pattern is a 4 the Gleason score is 3+4=7. This is less abnormal than 4+3=7. When the four is first the cells are more abnormal and treatment may need to begin. 

Prostate Cancer Grades

The grade of cancer tells the oncologist more about how fast the cells are likely to reproduce and how abnormal the cells look under a microscope. There are five grades for prostate cancer and they're related to the Gleason score.

Grade 1: Gleason score of 6 or less
Grade 2: Gleason score of 3+4=7
Grade 3: Gleason score of 4+3=7
Grade 4: Gleason score of 8
Grade 5: Gleason score of 9 or 10

The Gleason score is related to how prostate cancer is staged.