Prostate Cancer (cont.)
How is prostate cancer
diagnosed?
Prostate cancer is diagnosed from the results of a biopsy
of the prostate gland. If the digital rectal exam of the prostate or the PSA
blood test is abnormal, a prostate cancer is suspected. A biopsy of the
prostate is usually then recommended. The biopsy is done from the rectum
(trans-rectally) and is guided by ultrasound images of the area. A small piece
of prostate tissue is withdrawn through a cutting needle. The TRUS-guided Tru-Cut biopsy is currently the standard method to diagnose prostate cancer. Classically a 6-core set is taken by sampling the base, apex and mid gland on each side of the gland. More cores may be sampled to increase the yield, especially in larger glands. A pathologist then
examines the tissue under a microscope for signs of cancer in the cells of the
tissue.
When prostate cancer is diagnosed on the biopsy tissue,
the pathologist will then grade each of two pieces of the tissue from 1 to 5 on
the Gleason scale. The scale is based on certain microscopic characteristics of
the cancerous cells and reflects the aggressiveness of the tumor. The two
scores are then added together. Sums of 2 to 4 are considered low, indicating a
slowly growing tumor. Sums of 5 and 6 are intermediate, representing an
intermediate degree of aggressiveness. Sums of 7 to 10 are considered high,
signaling a rapidly growing tumor with the worst prognosis (outcome).
Gleason scores can be helpful in guiding treatment that is
based, at least in part, on the aggressiveness of the tumor. The principal
application of the Gleason score, however, is in predicting the risk for death
from a prostate cancer. The tumor grade strongly affects the prognosis. Higher tumor grades are more frequently associated with lymph node and distant spread (metastases). Thus, recent studies have shown that men with Gleason
scores of 2 to 4 face a minimal risk (4 to 7%) of death from prostate cancer
over the ensuing 15 years, while men with scores of 8 to 10 face a high risk
(60 to 87%) of death from prostate cancer over the 15 year period.
Next: How is the staging of prostate cancer done? »
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