What Does It Mean When There Are Different Core Samples With Different Gleason Scores
Cores may be samples from different areas of the same tumor or different tumors in the prostate. Because the grade may vary within the same tumor or between different tumors, different samples taken from your prostate may have different Gleason Scores. Typically, the highest Gleason Score will be the one used by your doctor for predicting your prognosis and deciding treatment.
Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
Staging Of Prostate Cancer
The stage of a cancer describes its size and how far it has spread. The results of your tests help your doctors decide on the stage and plan your treatment.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We’re here if you need someone to talk to. You can:
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What Should My Free Psa Level Be
Free PSA is the form of prostate specific antigen that is produced by benign cells of prostate gland, finding 10% of total PSA as Free is acceptable for healthy men. The lower the riskier.Benign prostate tumors normally show Free PSA percentage higher than 10%.Carcinogen cells reducing free PSA percentage to less than 10% and raise the values of total PSA due to the increasing of complexed PSA by cancer cells, from PSA blood test explainedLow PSA level, what does it mean?The normal PSA level is 0 but it can rise to up 4 with infection or other minor issues.A PSA of 0.6 is good and would not normally need further blood tests.PSA 1.0 is lower than men limit of PSA but is still not a cancer marker.If you have prostate cancer already and have had treatment, then 0.5, 1.0, or 2.0 is still nothing serious to worry about.The same is applied for PSA 2.0 or 3.0: means youre a cancer free or have your treatment course succeeded and lowered the PSA percentage.A problem with prostate production of prostate specific antigen can lead to very low PSA level.Diminished free PSA with normal PSA total is not fully understood.
In Men Over : Bph May Be The Cause Of High Psa
Benign prostatic hyperplasia is an enlargement of the prostate gland, but its not prostate cancer. “BPH means more cells, so that means more cells making PSA,” explains Dr. Castle.
BPH is the most common prostate problem in men over age 50. It may not need to be treated unless its causing frequent or difficult urination.
Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
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What Do My Test Results Mean
Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.
How far has my cancer spread?
The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.
Depending on the results, your cancer may be treated as:
- localised prostate cancer it’s contained inside the prostate
- locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
- advanced prostate cancer its spread from the prostate to other parts of the body.
Is my cancer likely to spread?
Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.
Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer.
Your cancer may be low risk if:
- your PSA level is less than 10 ng/ml, and
- your Gleason score is 6 or less , and
- the stage of your cancer is T1 to T2a.
Your cancer may be medium risk if:
- your PSA level is between 10 and 20 ng/ml, or
- your Gleason score is 7 , or
- the stage of your cancer is T2b.
What happens next?
Figure 2 Why Understaging May Occur
When the prostate is removed, a pathologist examines slices of the gland for evidence of cancer. A. Under a microscope, the pathologist can distinguish tiny tumors, consisting of clumps of visibly abnormal cells. B. With current imaging technology, it is not yet possible for a pathologist to identify micrometastases individual cancer cells shed from the primary tumor that have gone on to seed adjacent tissue. In this image, for example, cancer cells have already penetrated the capsule and migrated to adjacent tissue, even beyond the margin of tissue removed during surgery.
Individual prostate cancer cells can spread to more remote areas of the body in three ways . Whats more, they can do so without being detected with our current technology, essentially escaping under the radar. So its always possible even if you are diagnosed with early-stage prostate cancer that the cancer has already spread and will manifest in the coming years. How likely is it that an early-stage prostate cancer will become active without treatment? A small study provides some clues .
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How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the American Joint Committee on Cancers TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
- grade groups
What Should I Expect If Im Told I Have Elevated Psa
If your provider finds an elevated PSA level, youll have repeat tests to check your prostate. Many men with elevated PSA levels even those who have prostate cancer live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.
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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 National Cancer Institute , cancer tissue that looks most like normal tissue is grade 1. If the cancer tissue spreads through the prostate and deviates widely from the features of normal cells, it is grade 5.
What Is The Test To See If I Have Elevated Psa
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
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Psa Level Risk Analysis
- 15% of men with a PSA level less than 4 ng/ml go on to develop prostate cancer.
- 31% of men with PSA levels between 4 10 ng/ml have shown to develop prostate cancer.
- 50% 65% of men with psa scores over 10 ng/ml develop prostate cancer.
An important part of the your results is finding both the
1. Total amount of PSA in your blood.
2. Ratio of free vs bound PSA.
The Number Staging System
There are a few different systems used for staging prostate cancer. A simplified number staging system is described below.
- Stage 1 The tumour is contained in the prostate. The tumour is too small to be felt when a doctor does a rectal examination or to be seen on a scan.
- Stage 2 The tumour is still contained in the prostate, but your doctor can feel it when they do a rectal examination.
- Stage 3 The tumour has started to break through the outer capsule of the prostate and may be in the nearby tubes that produce semen .
- Stage 4 The tumour has spread outside the prostate. It may have spread to areas such as the bladder or back passage . Or it may have spread further, for example to the bones.
Using the numbered staging system described above:
- stage 4 is known as advanced prostate cancer.
The grade of a cancer gives an idea of how quickly the cancer might grow or spread. A doctor decides the grade of the cancer by how the cancer cells look under the microscope.
Doctors look at the grade of the cancer to help them plan your treatment.
Gleason is the most commonly used grading system for prostate cancer.
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Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.
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.
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What Does It Mean If My Biopsy Report Mentions The Word Core
The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor inserts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a core. This is often repeated several times to sample different areas of the prostate.
Your pathology report will list each core separately by a number assigned to it by the pathologist, with each core having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what is going on with you.
Diagnostic Tests Are Limited
We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.
As PSA screening has grown more widespread, we are finding more tumors that otherwise would have escaped detection. Yet current diagnostic technology does not always enable urologists to determine which tumors will lie dormant and which will become active, spreading elsewhere in the body.
Studies estimate that anywhere from 16%56% of men diagnosed with prostate cancer, generally because of an abnormal PSA test, have tumors that might never have caused problems had they not been found. And the landmark Prostate Cancer Prevention Trial unexpectedly yielded data that early-stage prostate tumors are incredibly common, even at PSA levels considered normal.
The PCPT was a randomized controlled study the type considered to be the gold standard in research . The study, which involved almost 19,000 healthy men, was designed to evaluate whether the drug finasteride could prevent prostate cancer from developing. Finasteride is a hormonal medication originally approved to treat benign prostatic hyperplasia , but which has also been investigated as a potential treatment for prostate cancer.
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What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
What Is The Gleason Score
The Gleason score will be described using a number from 6 to 10. The pathologist will add the two most common grades together to make the Gleason score.
If the most common grade in the sample is 3, and the second most common grade in the sample is 4, then your Gleason score will be 7 . If only one grade is found, then this grade is added to itself. So if all the sample is only grade 3, then the Gleason score will be 6 .
- Lower grades are slower growing.
- Higher grades are faster growing.
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What Does Staging And Grading Mean For Treatment
These two numbers are the most important for determining your future course of treatment. Some treatments are only effective for Stages I and II, where the cancer is still confined to the prostate. Some other treatments only become necessary at Stages III and IV, where the cancer has spread outside the prostate.
Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with treatment. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance and avoid side effects.
In any case, the stage and grade should be a vital component of any discussion with your doctor.
What Is A Grade Group
In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.
The Grade Group system is simpler, with just five grades, 1 through 5.
*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.
Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.
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