Understanding prostate biopsy report-What do my test results mean? | Prostate Cancer UK

February 1, by PCRI. Although a urologist will typically be the person who presents the results of the biopsy to the patient, the official pathology report is generated by a pathologist—such as myself—a specialized physician with many years of training in the study and diagnosis of specimens removed by surgery or by needle biopsy. The major components communicated in the report are the Gleason grade, which is a measure of how aggressive the tumor looks under the microscope, and the quantity of cancer. The quantity is judged two ways: The number of biopsy cores containing cancer assuming, as is usually the case, that the biopsy was performed using standard random techniques. For example, if only 2 of 12 cores contain small amounts of cancer, the quantity of cancer the presumed size of the tumor would be small.

What does it mean if in addition to cancer my biopsy report also says "high grade prostatic intraepithelial neoplasia" or "high grade PIN"? It can pick up a faster growing cancer at an early stage, when treatment may prevent the cancer from spreading to other parts of the body. In a Understanding prostate biopsy report trial, if someone is given a treatment that will harm them as in the above example or given a placebo in place of treatment or needed treatment is withheld, the patient may be deceived or harmed. This is because the Understanding prostate biopsy report can cause the prostate to Mcquaid nurse forensic, so they'll want to make sure you can urinate properly before you leave. Your doctor should talk to you about the advantages and disadvantages of having a biopsy. QOL quality of life issues have not been adequately addressed.

Yougest girls have sex with daddy. What are the advantages and disadvantages of having a biopsy?

If there is more than one sample, this section may designate a letter or number system to distinguish each sample. 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 Gleason systems uses numbers ranging from 1 to 5 to rate the potential aggressiveness of the cells that compose the cancer. Inflammation of the prostate is called prostatitis. Having a copy of your pathology report for your personal records is highly recommended. Although eventually the Grade Group system may replace the Gleason system, the two systems are currently reported side-by-side. The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated. Identifies from Unedrstanding area in the prostate an individual tissue core was taken: apex part of the prostate furthest from the bladdermid-zone middleor base part of the prostate nearest the bladder. This is not a cause for concern. It includes the tumor type Understanding prostate biopsy report cell of origin. Atrophy is a term used to describe shrinkage of prostate tissue when it is seen Undsrstanding the microscope. The seminal vesicles are glands that lie just behind the prostate. Close Select A Hope Lodge. Your pathology report will list each core separately by Understandlng number or Understanding prostate biopsy report assigned to it by the pathologist, with each core biopsy sample having its own Fairmont vanities. Procedure: Dorm loft site procedure describes how the tissue sample was removed.

The pathologist has just looked under the microscope at 12 tissue samples from your prostate.

  • It is clearly an upsetting experience for a patient to be told that cancer has been found on a prostate biopsy.
  • 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.
  • 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.
  • 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.
  • Understanding the pathology report of a prostate biopsy.
  • 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.

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. 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 or letter assigned to it by the pathologist, with each core biopsy sample 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.

Adenocarcinoma is the type of cancer that develops in gland cells. It is the most common type of cancer found in the prostate gland. Pathologists grade prostate cancers using numbers from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope.

This is called the Gleason system. Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score also called the Gleason sum. The highest a Gleason score can be is The first number assigned is the grade that is most common in the tumor.

Although most often the Gleason score is based on the 2 areas that make up most of the cancer, there are some exceptions when a core sample has either a lot of high-grade cancer or there are 3 grades including high-grade cancer. In these cases, the way the Gleason score is determined is modified to reflect the aggressive nature of the cancer.

The higher the Gleason score, the more likely it is that your cancer will grow and spread quickly. Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6.

These cancers may be called well differentiated or low-grade and are likely to be less aggressive; that is, they tend to grow and spread slowly. Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8. 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 cores taken from your prostate may have different Gleason scores. Typically, the highest largest number Gleason score will be the one used by your doctor for predicting your prognosis and deciding on treatment options. However, in about 1 out of 5 cases the biopsy grade is lower than the true grade because the biopsy misses a higher grade more aggressive area of the cancer. It can work the other way, too, with the true grade of the tumor being lower than what is seen on the biopsy.

The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:. Grade Groups are a new way to grade prostate cancer to address some of the issues with the Gleason grading system.

As noted above, currently in practice the lowest Gleason score that is given is a 6, despite the Gleason grades ranging in theory from 2 to This understandably leads some patients to think that their cancer on biopsy is in the middle of the grade scale. This can compound their worry about their diagnosis and make them more likely to feel that they need to be treated right away. Another problem with the Gleason grading system is that the Gleason scores are often divided into only 3 groups 6, 7, and Similarly, Gleason scores of 9 or 10 have a worse prognosis than Gleason score 8.

To account for these differences, the Grade Groups range from 1 most favorable to 5 least favorable :. Although eventually the Grade Group system may replace the Gleason system, the two systems are currently reported side-by-side. These are special tests that the pathologist sometimes uses to help diagnose prostate cancer. Not all patients need these tests.

Whether or not your report mentions these tests has no effect on the accuracy of your diagnosis. Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.

It is not important in someone who already has prostate cancer. In this case, the term 'high-grade' refers to the PIN and not the cancer, so it has nothing to do with the Gleason score or how aggressive your cancer is. Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase your PSA level, but it is not linked to prostate cancer.

The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated. All of these are terms for things the pathologist might see under the microscope that are benign not cancer , but that sometimes can look like cancer.

Atrophy is a term used to describe shrinkage of prostate tissue when it is seen under the microscope. When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy.

Focal atrophy can sometimes look like prostate cancer under the microscope. Atypical adenomatous hyperplasia which is sometimes called adenosis is another benign condition that can sometimes be seen on a prostate biopsy. The seminal vesicles are glands that lie just behind the prostate. Sometimes part of a seminal vesicle is sampled during a biopsy. This is not a cause for concern. Finding any of these is not important if prostate cancer is also present.

These tests can help predict the prognosis outlook of your prostate cancer, and the results should be discussed with your doctor. The results do not affect your diagnosis, although they might affect your treatment options.

This series of Frequently Asked Questions FAQs was developed by the Association of Directors of Anatomic and Surgical Pathology to help patients and their families better understand what their pathology report means. Learn more about the FAQ Initiative. 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.

What does it mean if my biopsy report mentions the word core? What is adenocarcinoma? What is the Gleason grade or Gleason score? If the cancerous tissue looks much like normal prostate tissue, a grade of 1 is assigned. If the cancer cells and their growth patterns look very abnormal, a grade of 5 is assigned. Grades 2 through 4 have features in between these extremes.

What does it mean to have a Gleason score of 6, 7, 8, or ? What does it mean when there are different core samples with different Gleason scores?

Can the Gleason score on my biopsy really tell what the cancer grade is in the entire prostate? How important is the Gleason score?

Still, other factors are also important, such as: The blood PSA level Findings on rectal exam Findings on imaging tests How much of each core is made up of cancer The number of cores that contain cancer Whether cancer was found in both sides of the prostate Whether the cancer has spread outside the prostate What are Grade Groups? What does it mean if my biopsy mentions that there is perineural invasion? What does it mean if, in addition to cancer, my biopsy report also says high-grade prostatic intraepithelial neoplasia or high-grade PIN?

What does it mean if, in addition to cancer, my biopsy report also mentions acute inflammation acute prostatitis or chronic inflammation chronic prostatitis? What does it mean if my biopsy report also mentions atrophy, adenosis, or atypical adenomatous hyperplasia? What does it mean if my biopsy report mentions a seminal vesicle? What does it mean if, in addition to cancer, my biopsy report also says atypical glands, atypical small acinar proliferation ASAP , glandular atypia, or atypical glandular proliferation?

What does it mean if my doctor asks for a special molecular test to be done on my biopsy specimen? Written by. Image of. Close Select A Hope Lodge.

Aug What does it mean if, in addition to cancer, my biopsy report also says high-grade prostatic intraepithelial neoplasia or high-grade PIN? Focal atrophy can sometimes look like prostate cancer under the microscope. Still, other factors are also important, such as:. All of these are terms for things the pathologist might see under the microscope that are benign not cancer , but that sometimes can look like cancer.

Understanding prostate biopsy report. Gleason Score

Since prostate cancer is the second most common cancer in men after skin cancer, this is an important test for men to have done regularly.

PSA is a protein produced by normal as well as malignant cells of the prostate gland and is found in the blood. If a man has an abnormal PSA test this usually results in a prostate biopsy — the only way to confirm the presence of prostate cancer. A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate to examine under a microscope for signs of prostate cancer.

A biopsy of the prostate is not to be taken lightly as it can result in pain, bleeding, and infection. Before the procedure, to help reduce discomfort and get the best results, men should discuss the procedure in detail with their doctor. The doctor can minimize these effects by using conscious sedation or an anesthetic called a prostatic block and by prescribing a course of antibiotics at the time of the biopsy.

A urologist will perform the biopsy of the prostate which can be done in several different ways:. This is done through the rectum and is the most common. Using an ultrasound probe in the rectum, a special needle is inserted into the prostate gland via the rectum to collect prostate tissue samples. This is done through the urethra using a cystoscope a flexible tube and viewing device which is inserted through the opening of the urethra at the tip of the penis. Tissue samples are then collected from the prostate through the scope.

This is done through the skin between the scrotum and the rectum. A small incision is made in the perineum and a biopsy needle is then inserted through the incision and into the prostate several times to get samples from different areas of the prostate.

After the prostate is biopsied, the samples will be taken to a laboratory to be examined under a microscope by a pathologist. Spotting cancer using a microscope can be difficult as there can be substances within the cells that look like cancer but yet are not. The pathologist will want to be very careful and cautious when diagnosing prostate cancer as the biopsy samples are usually quite small. No man wants to have a repeat of a prostate biopsy.

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.

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 or letter assigned to it by the pathologist, with each core biopsy sample 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.

Adenocarcinoma is the type of cancer that develops in gland cells. It is the most common type of cancer found in the prostate gland. Pathologists grade prostate cancers using numbers from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope.

This is called the Gleason system. Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score also called the Gleason sum. The highest a Gleason score can be is The first number assigned is the grade that is most common in the tumor.

Although most often the Gleason score is based on the 2 areas that make up most of the cancer, there are some exceptions when a core sample has either a lot of high-grade cancer or there are 3 grades including high-grade cancer. In these cases, the way the Gleason score is determined is modified to reflect the aggressive nature of the cancer. The higher the Gleason score, the more likely it is that your cancer will grow and spread quickly. Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6.

These cancers may be called well differentiated or low-grade and are likely to be less aggressive; that is, they tend to grow and spread slowly. Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade.

These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8. 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 cores taken from your prostate may have different Gleason scores. Typically, the highest largest number Gleason score will be the one used by your doctor for predicting your prognosis and deciding on treatment options. However, in about 1 out of 5 cases the biopsy grade is lower than the true grade because the biopsy misses a higher grade more aggressive area of the cancer.

It can work the other way, too, with the true grade of the tumor being lower than what is seen on the biopsy. The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:. Grade Groups are a new way to grade prostate cancer to address some of the issues with the Gleason grading system. As noted above, currently in practice the lowest Gleason score that is given is a 6, despite the Gleason grades ranging in theory from 2 to This understandably leads some patients to think that their cancer on biopsy is in the middle of the grade scale.

This can compound their worry about their diagnosis and make them more likely to feel that they need to be treated right away.

Gleason Score - Prostate Conditions

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 pathology report tells your treating doctor the diagnosis in each of the samples to help manage your care.

This FAQ sheet is designed to help you understand the medical language used in the pathology report. What is "adenocarcinoma of the prostate"? Adenocarcinoma of the prostate is a type of cancer tumor with a wide range of behavior from cases which are very slow growing with a low risk of causing men harm to cases which are more aggressive. What is a "core"? The urologist samples the prostate by removing thin threads of tissue with a hollow needle, each one referred to as a "core", from different areas of the prostate.

What is the "Gleason grade" or "Gleason score"? The Gleason score is a measurement of how aggressive your tumor is likely to be. It is made by a pathologist looking at the cancer under the microscope. Prostate cancer can have several patterns under the microscope, which are each assigned a different number.

The first number in the score is the most common and the second number in the score is the next most common pattern seen under the microscope. The individual patterns typically range 3 to 5 on biopsy, with 3 being least aggressive and 5 the most aggressive.

They are added together to get your total "Gleason grade" or "Gleason score", which typically ranges from 6 to What does it mean to have a Gleason score of 6 or 7 or ?

The lowest Gleason score least aggressive tumor that is typically present on prostate biopsy is a 6 with higher grades maximum Gleason score 10 corresponding to progressively more aggressive tumors.

What does it mean when there are different cores with different Gleason scores? Different cores may sample 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 largest number Gleason score will be the one used by your doctor in predicting prognosis and deciding therapy.

Does the Gleason score on my biopsy accurately indicate what the cancer grade is in the entire prostate? In some cases, the biopsy grade can also overestimate the aggressiveness of the tumor, where the true grade of the tumor may be lower than what is seen on the biopsy. How important is the Gleason score? The Gleason score is one of the most powerful predictors of the behavior of prostate cancer but must be factored in with other information, such as the PSA blood test level, findings on rectal exam, number of cores involved by cancer, and in some cases radiology imaging studies to fully predict how the tumor will behave.

These are special tests that the pathologist sometimes uses to help make the diagnosis of prostate cancer. Not all cases need these tests. Whether your report does or does not mention these tests has no bearing on the accuracy of your diagnosis. What does it mean if my biopsy mentions that there is "perineural invasion". Even with perineural invasion your cancer could still be very curable depending on other factors. In some cases, it may affect treatment and in other cases it has no significance.

How this finding will affect your specific treatment is best discussed with your treating doctor. What does it mean if in addition to cancer my biopsy report also says "high grade prostatic intraepithelial neoplasia" or "high grade PIN"?

The word "high grade" as it refers to prostatic intraepithelial neoplasia has no relation to the Gleason system and does not indicate a more aggressive tumor.

What does it mean if in addition to cancer my biopsy report also says "acute inflammation" acute prostatitis or "chronic inflammation" chronic prostatitis? In some cases inflammation may increase the PSA blood test level but in most cases it is of no importance and has nothing to do with prostate cancer. What does it mean if my biopsy report also says "atrophy" or "adenosis" or "atypical adenomatous hyperplasia" or "seminal vesicle"? All of these terms are things that the pathologist sees under the microscope that in some cases can look like cancer but are of no importance when seen on the biopsy and has nothing to do with cancer.

What does it mean if in addition to cancer my biopsy report also says "atypical glands" or "atypical small acinar proliferation ASAP " or "glandular atypia" or "atypical glandular proliferation"? All of these terms are things that the pathologist sees under the microscope that are of no importance when seen on the biopsy if there is cancer elsewhere on the sampling.