Getting the results

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 DRE shows that your prostate is larger than expected this could be a sign of an enlarged prostate. A prostate 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 to show how far the cancer might have spread.

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Gleason grade and Gleason score

Your doctor may talk about your Gleason grade and Gleason score after your biopsy.

Gleason grade

Prostate cancer cells in your biopsy samples are given a Gleason grade. This tells you how aggressive the cancer is – in other words, how likely it is to grow and spread outside the prostate.

When cancer cells are seen under the microscope, they have different patterns, depending on how quickly they’re likely to grow. The pattern is given a grade from 1 to 5. This is called the Gleason grade. If a grade is given, it will usually be 3 or higher, as grades 1 and 2 are not cancer.

Gleason score

There may be more than one grade of cancer in the biopsy sample. An overall Gleason score is worked out by adding together two Gleason grades.

The first is the most common grade in all the samples. The second is the highest grade of what’s left. When these two grades are added together, the total is called the Gleason score.

For example, if the biopsy samples show that:

  • most of the cancer seen is grade 3 and
  • the highest grade of any other cancer seen is grade 4, then
  • the Gleason score will be 7 (3+4).

A Gleason score of 4+3 shows that the cancer is slightly more aggressive than a score of 3+4, as there is more grade 4 cancer.

If you have prostate cancer, your combined Gleason score will be between 6 (3+3) and 10 (5+5). You might only be told your total Gleason score, and not your Gleason grades.

What does the Gleason score mean?

The higher the Gleason score, the more aggressive the cancer, and the more likely it is to spread.

  • 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 you 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.

  • The T stage shows how far the cancer has spread in and around the prostate.
  • The N stage shows whether the cancer has spread to the lymph nodes.
  • The M stage shows whether the cancer has spread to other parts of the body.

T Stage

The T stage shows how far the cancer has spread in and around the prostate. A DRE is usually used to find out the T stage. You might also have an MRI scan or a CT scan to confirm your T stage.

T1 prostate cancer
The cancer can’t be felt or seen on scans, and can only be seen under a microscope – localised prostate cancer.

T1 prostate cancer

 

T2 prostate cancer
The cancer can be felt or seen on scans, but is still contained inside the prostate – localised prostate cancer.

T2 Prostate Cancer

 

T3 prostate cancer
The cancer can be felt or seen breaking through the capsule of the prostate – locally advanced prostate cancer.

  • T3a The cancer has broken through the capsule of the prostate but has not spread to the seminal vesicles (which produce some of the fluid in semen).
  • T3b The cancer has spread to the seminal vesicles.

T3 Prostate Cancer

 

T4 prostate cancer
The cancer has spread to nearby organs, such as the neck of the bladder, back passage, pelvic wall or lymph nodes – locally advanced prostate cancer.

T4 Prostate CancerN Stage

The N stage shows whether the cancer has spread to the lymph nodes near the prostate - a common place for prostate cancer to spread to.

An MRI or CT scan is used to find out your N stage. You may need an MRI or CT scan if you’re thinking about having a treatment such as radiotherapy or surgery and there is a risk your cancer might have spread to your lymph nodes.

The possible N stages are:

  • NX The lymph nodes were not looked at, or the scans were unclear.
  • N0 No cancer can be seen in the lymph nodes.
  • N1 The lymph nodes contain cancer.

If your scans suggest that your cancer has spread to the lymph nodes (N1), it may either be treated as locally advanced or advanced prostate cancer. This may depend on several things, such as how far it has spread (M stage).

M Stage

The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones.

A bone scan is usually used to find out the M stage. Your doctor may offer you a bone scan if they think your cancer might have spread.

  • MX The spread of the cancer wasn’t looked at, or the scans were unclear.
  • M0 The cancer hasn’t 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 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's contained inside the prostate. You may also hear it called early or organ-confined prostate cancer.

Prostate cancer can behave in different ways. Localised prostate cancer often grows slowly – or might not grow at all – and has a low risk of spreading. So it may never cause you any problems or affect how long you live. However, some cancers may grow more quickly and spread to other parts of the body.

The tests you have will help your doctor find out how your cancer is likely to behave, and what treatments might be suitable for you.

Is my cancer likely to spread?

Your doctor may talk about the risk of your cancer coming back after treatment. This will help you and your doctor to discuss the best treatments for you.

Low risk

  • your PSA level is less than 10ng/ml, 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.

High risk

  • your PSA level is higher than 20 ng/ml, or
  • your Gleason score is 8, 9 or 10, or
  • the stage of your cancer is T2c, T3 or T4.

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Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has started to break out of the prostate, or has spread to the area just outside the prostate. It may have spread to the seminal vesicles, pelvic lymph nodes, neck of the bladder or back passage (rectum).

Different doctors may use the term 'locally advanced prostate cancer' to mean slightly different things, so ask your doctor or nurse to explain exactly what they mean.

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Advanced prostate cancer

Advanced (metastatic) prostate cancer is cancer that has spread from the prostate to other parts of the body. It develops when 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 most commonly to the bones and the lymph nodes.

Advanced prostate cancer can cause symptoms, such as fatigue (extreme tiredness), bone pain and problems urinating. The symptoms you have will depend on where the cancer has spread to. Some men with advanced prostate cancer only get a few symptoms.

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What happens next?

Your test results will help your multi-disciplinary team (MDT) - the team of health professionals involved in your care - to find out how your cancer is likely to behave, and what treatments might be suitable for you.

If you're 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 the treatment options available. Or you could call our Specialist Nurses for more information or support, or speak to a nurse online. 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. Make sure you have all the information you need, and give yourself time to think about what is right for you. Your doctor or nurse can help you think about the pros and cons.

It can help to write down any questions you want to ask at your next appointment. And to write down or record what’s said to help you remember it. It can also help to take someone to appointments, such as your partner, friend or family member. There is also support available.

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Rare types of prostate cancer

As well as giving the Gleason score, a biopsy also looks at the type of cancer cells. For most men who are diagnosed, the type of prostate cancer is adenocarcinoma, or acinar adenocarcinoma. You might see this written on your pathology report. There are other types of prostate cancer, which are very rare. These include:

  • small cell prostate cancer (neuroendocrine prostate cancer)
  • large cell prostate cancer (neuroendocrine prostate cancer)
  • ductal prostate cancer (ductal adenocarcinoma)
  • mucinous prostate cancer (mucinous adenocarcinoma)
  • signet ring cell prostate cancer
  • basal cell prostate cancer (adenoid cystic prostate cancer)
  • prostate sarcomas, such as leiomyosarcoma.

If you are diagnosed with one of these rare kinds of prostate cancer, you can read more here. Speak to your doctor or nurse about what it means and about the treatments available to you.

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Questions to ask your doctor or nurse

  • What is my PSA level?
  • Will I need a biopsy? What type of biopsy will I have?
  • What are the risks and side effects of having a biopsy?
  • 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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References

You can find a full list of references used to produce this page in our online fact sheet.