IF SCREENING (Prostate Surface Antigen(PSA)/Digital
Rectal Exam(DRE) SUGGEST PROSTATE CANCER, WHAT NEXT:
If cancer is seen, it will also be assigned a grade. This is often expressed as a Gleason score.
Whether the cancer has spread outside the prostate.
If cancer is seen, it will also be assigned a grade. This is often expressed as a Gleason score.
What do the numbers in the Gleason score mean, for example 3+4=7 or 3+3=6?
Grades 2 through 4 have features in between these extremes. Since prostate cancers often have areas with different grades.Whether the cancer has spread outside the prostate.
1)
Transrectal ultrasound (TRUS)
·
A small ultra sound probe (about
the width of a finger) is placed in the rectum after lubrication.
·
The probe gives off sound waves
that enter the prostate and create echoes. The probe picks up the echoes, and a
computer turns them into a black and white image of the prostate.
·
This procedure often takes less
than 10 minutes and is done in as an OPD procedure. There is no pain but
uncomfortable sensation may be there.
·
TRUS is not used as a screening
test for prostate cancer because it can’t always tell the difference between
normal tissue and cancer.Instead, it is most often used to look for prostate
cancer when a man has symptoms or has an abnormal PSA level or digital rectal
exam (DRE).
·
It is also used during a prostate
biopsy to guide the biopsy needles into the correct area of the prostate.
2) Prostate biopsy
·
A biopsy is a procedure in which
small samples of the prostate are removed and then looked at under a
microscope.
·
A core needle biopsy is the main
method used to diagnose prostate cancer.
·
It is usually done by an
urologist, a surgeon who treats cancers of the genital and urinary tract, which
includes the prostate gland.
·
Using TRUS to “see” the prostate
gland, the doctor quickly inserts a thin, hollow needle through the wall of the
rectum and into the prostate.
·
When the needle is pulled out, it
removes a small cylinder (core) of prostate tissue. This is repeated several
times. Most urologists will take about 12 core samples from different parts of
the prostate.
·
Though the procedure sounds
painful, each biopsy usually causes only a brief uncomfortable sensation
because it is done with a special spring-loaded biopsy instrument. The device
inserts and removes the needle in a fraction of a second.
·
Most doctors who do the biopsy
will numb the area first with local anesthetic.
·
The biopsy itself takes about 10
minutes and is usually done as an OPD procedure.
·
The Urologist may prescribe
antibiotics to take before the biopsy and for a day or 2 after procedure, to
reduce the risk of infection.
·
For a few days after the
procedure, there maybe some soreness in the area and one may probably notice
blood in urine.
·
There may also be some light
bleeding from the rectum, especially if one has hemorrhoids.
·
Many men notice blood in their
semen or have rust-colored semen.
·
Biopsy samples will be sent to a
lab, where they will be looked at with a microscope to see if they contain
cancer cells. This normally takes 2-3 days.
·
Adenocarcinoma is the commonest form of prostate cancer which occurs in the
glandular part of the prostate.
What is the Gleason grade or Gleason score?
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.
·
Grades 1 and 2 are not often used
for biopsies − most biopsy samples are grade 3 or higher.
·
If the cancerous tissue looks
much like normal prostate tissue, it is graded as 1.
·
If the cancer cells and their
growth patterns look very abnormal, it is graded as 5.
·
The grades are 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 first number assigned is the
grade that is most common in the tumor. For example, if the Gleason score is
written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4 and
they are added for a Gleason score of 7.
·
The highest a Gleason score can
be is 10.
·
The higher the Gleason score, the
more likely it is that your cancer will grow and spread quickly.
What does it mean to have a Gleason score of 6 or 7 or 8-10?
·
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 – 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 tend to
be aggressive, meaning they are likely to grow and spread more quickly.
·
Cancers with a Gleason score of 7
may be called moderately differentiated or intermediate grade. The rate at
which they grow and spread tends to be in between.
How important is the Gleason score?
The
Gleason score is very important in predicting the behavior of a prostate
cancer.
However
other factors are also important, such as
·
The PSA level,
·
Findings on rectal exam,
·
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, and
Even
when taking many samples, biopsies can still sometimes miss a cancer if none of
the biopsy needles pass through it. This is known as a false-negative result.
If your
doctor still strongly suspects you have prostate cancer (because your PSA level
is very high, for example) a repeat biopsy may be needed to help be sure.
Prostate
biopsy results are sometimes called suspicious.
Suspicious
results mean that the cells don’t look like cancer, but they don’t look quite
normal, either.
If the biopsy results come back suspicious, doctor may want to
repeat the biopsy.
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