By: John Jurige, M.D.
It is clearly an upsetting experience for a patient to be told that cancer has been found on a prostate biopsy. Usually, a patient receives this news at the same time that discussions about treatment options are undertaken. Some of the information included in a prostate biopsy report is confusing to many patients. All of the information is important.
The following suggestions and explanations should be helpful.
First of all, request a copy of the pathology report from your urologist. This will give you the opportunity to review all of the information included in the report at your own pace and in a more relaxed environment.
Almost all prostate cancers are classified as ADENOCARCINOMA. This is a type of cancer that originates in the microscopic gland elements of the prostate, rather than the smooth muscle tissue.
All prostate cancers are graded using the Gleason scoring system, which can be confusing. The Gleason systems uses numbers ranging from 1 to 5 to rate the potential aggressiveness of the cells that compose the cancer. Many prostate cancers contain two different populations of cells, so the Gleason score is given as a sum in which the most common Gleason cell type is given as the first number, and the second cell type comes next. For example, if the Gleason score is 3+4, the most common cellular component is a 3, and the secondary type is 4. The TOTAL Gleason score in this example is 7.
It is important for patients to know that only Gleason scores of 3, 4, and 5 are commonly seen in patient’s biopsy results, meaning that the TOTAL Gleason score will range from 6 to 10.
In general, TOTAL Gleason scores of 6 and 7 are considered potentially less aggressive prostate cancers, especially those scored as 3+3 or 3+4.
Next, the report will explain the number, location, and percentage of each sample that contain either benign or cancerous elements. For example, “prostate adenocarcinoma, Gleason score 3+3, involving 10% of both samples from the left base of the prostate.” The percentage of cancer found in the sample is important since it reflects the likelihood of cancer involvement in a particular area of the prostate.
Several other terms are often seen in a biopsy report and require explanation:
Prostate Intraepithelial Neoplasia (PIN) is a microscopic entity showing changes in the glandular elements of the prostate that are generally considered BENIGN changes. Patients with this finding will continue to require ongoing followup of the prostate based on physician recommendations.
Atypical small cell acinar proliferation (ASAP) is a more concerning finding that may require repeat biopsy at a later date.
Perineural invasion indicates that cancer cells are found in close proximity to microscopic nerve tissue. The significance of this finding is controversial, but might alter the decision to recommend active surveillance for prostate cancer.
Acute prostatitis indicates evidence of active infection within the prostate and requires antibiotic therapy. Prostatitis is a common BENIGN cause for PSA elevation. Patients are encouraged to ask questions about their biopsy report, since it forms the foundation for decision making about treatment options.