It usually takes around two weeks to get all the results. These
can give an indication of how far the cancer has spread and how
quickly it might be growing.
- If your PSA test shows that you have a high PSA level
for your age, this could be a sign of prostate cancer, but it can
also be caused by other things.
- If your digital rectal examination shows that your prostate
gland is larger than expected this could be a sign of an enlarged
prostate. A prostate gland with hard, bumpy areas may suggest
prostate cancer.
- If your biopsy shows there is
cancer present, the results are used to work out your Gleason score. This
can give an idea of how likely the cancer is to spread.
- The results of any scans you might have had
will help to stage
your cancer.
Contents:
Gleason score
Any cancer found in your biopsy samples is graded to show how
active it is. The pathologist looks at the pattern made by the
cancer cells and gives that pattern a grade from 1 to 5. This is
called Gleason grading.
The pathologist may see more than one grade of cancer in the
biopsy samples. The grades of the most common pattern and pattern
with the highest grade are added together to give a "Gleason
score".
For example, if the biopsy shows that:
- most of the cancer seen is grade 3, and
- the highest grade of cancer seen is grade 4, then
- the Gleason will be 3 + 4, and the Gleason score will be
7.
Gleason scores run from 2 to 10. Doctors usually only give a
Gleason grade of 3 or more, so your Gleason score will normally be
between 6 and 10.
The higher the Gleason score, the more aggressive the cancer and
the more likely it is to spread.
What the Gleason score means:
- 3+3 - All of the cancer cells found in the biopsy look likely
to grow slowly.
- 3+4 - Most of the cancer cells found in the biopsy look likely
to grow slowly. There were some cancer cells that look more likely
to grow at a more moderate rate.
- 4+3 - Most of the cancer cells found in the biopsy look likely
to grow at a moderate rate. There were some cancer cells that look
likely to grow slowly.
- 4+4 - All of the cancer cells found in the biopsy look likely
to grow at a moderately quick rate.
- 4+5 - Most of the cancer cells found in the biopsy look likely
to grow at a moderately quick rate. There were some cancer cells
that are likely to grow more quickly.
- 5+4 - Most of the cancer cells found in the biopsy look likely
to grow quickly.
- 5+5 - All of the cancer cells found in the biopsy look
likely to grow quickly.
Your doctor or nurse will talk through what your results
mean.
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Staging
Staging is a way of recording how far the cancer has spread. The
most common method is the TNM (Tumour-Nodes- Metastases) system.
This looks at the tumour (T), lymph nodes (N) and whether the
cancer has spread to other parts of the body or metastasised
(M).
T stage
The T stage shows how far the cancer has spread in and around
the prostate gland. This is measured by a DRE. You may
also have an MRI scan to confirm your T
stage.
T1 The cancer cannot be felt and can only be
seen under a microscope - localised prostate cancer.
T2 The cancer can be felt or seen but it is
contained within the prostate gland - localised prostate
cancer.
T3 The cancer can be felt or seen breaking
through the capsule of the prostate gland - locally advanced
prostate cancer.
T4 The tumour has spread to nearby organs, such
as the bladder neck, back passage or pelvic wall - locally advanced
prostate cancer.
N Stage
The N stage shows whether the cancer has spread to the nearby lymph nodes. This is done using an MRI scan or CT scan. You
may be offered one of these scans if there is a risk that your
cancer has spread and the results will affect your treatment
options.
NX The lymph nodes were not looked at.
N0 The lymph nodes do not appear to contain
cancer cells.
N1 The lymph nodes appear to contain cancer
cells.
If your scan results suggest that your cancer has spread to
these lymph nodes (N1), it may either be treated as locally
advanced or advanced prostate cancer. This may
depend on several factors including the results of your M
stage.
M Stage
The M stage shows whether the cancer has spread (metastasised)
to other parts of the body, such as the bone. This is measured
using a bone scan.
Your doctor may offer you a bone scan if they think your cancer
may have spread.
MX The spread of the cancer was not looked
at.
M0 The cancer has not spread to other parts of
the body.
M1 The cancer has spread to other parts of the
body.
If you have a bone scan and the results show that your cancer
has spread to other parts of the body (M1), you will be diagnosed
with advanced
prostate cancer.
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Localised prostate
cancer
Localised prostate cancer is cancer that is contained within the
prostate gland. It is also called early or organ-confined prostate
cancer.
Prostate cancer can behave in different ways. Many localised
cancers are not aggressive and will not cause any problems in your
lifetime. However, some cancers may grow more quickly and spread to
other parts of the body.
The tests you have had can give
your doctor and idea of how the cancer will behave and what treatments may be
suitable for you.
What is the chance my cancer will spread?
Doctors often divide localised prostate cancers into risk
groups. This is the risk of the cancer coming back after treatment.
This is used to help decide which treatment options are suitable
for you.
Low risk
- your PSA level is 10ng/ml or less, and
- your Gleason score is 6 or less, and
- the stage of your cancer is T1 to T2a
Medium risk
- your PSA level is between 10 and 20ng/ml,
or
- your Gleason score is 7, or
- the stage of your cancer is T2b or T2c
High risk
- your PSA level is 20 ng/ml or higher, or
- your Gleason score is 8 or higher, or
- the stage of your cancer is T3 or T4.
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Locally
advanced prostate cancer
Locally advanced prostate cancer is cancer that is breaking
through the capsule of the prostate, or has spread to the area just
outside the prostate. This can include the seminal vesicles, lymph
nodes, neck of the bladder or back passage.
Different doctors sometimes use the term "locally advanced
prostate cancer" in slightly different ways, so ask your doctor or
nurse what it means in your case.
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Advanced prostate
cancer
Advanced prostate cancer is cancer that has spread from the
prostate gland to other parts of the body. It is also called
'metastatic' prostate cancer. It develops when tiny prostate cancer
cells move from the prostate to other parts of the body through the
blood stream or lymphatic system.
Prostate cancer can spread to any part of the body but it most
commonly spreads to the bones and the lymph nodes.
Advanced prostate cancer can cause symptoms, which may be the
first sign that something is wrong for some men. Symptoms will
depend on where the cancer has spread to, but can include bone pain
or problems passing urine. Not all men diagnosed with advanced
prostate cancer will have symptoms.
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What happens next?
The results will give your multi-disciplinary team (MDT) an idea
of how your cancer is behaving and the most suitable treatment
options for you.
If you are not sure whether your prostate cancer is localised,
locally advanced or advanced, speak to your doctor or nurse. They
can explain your test results and talk to you about your treatment options.
Or you can call our Specialist Nurses. You can also
request a second opinion from another specialist by talking to your
GP.
It can be hard to take everything in, especially when you've
just been diagnosed with prostate cancer. You might find it useful
to have someone with you at the consultation, or to make notes so
that you can read them in your own time. There is also support available.
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Questions to ask your
doctor or nurse
- What is my PSA level?
- Will I need a biopsy? What are the risks and side effects of
having a biopsy?
- How many biopsy samples will you take?
- What are my Gleason grades and Gleason score?
- Will I need an MRI, CT or bone scan?
- What is the stage of my cancer? What does this mean?
- What treatments are suitable for me?
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