How to Understand a Prostate Cancer Pathology Report

Categories: Prostate Cancer

June 12, 2020

To test a tumor for cancer, your doctor will schedule you for a prostate biopsy. A biopsy is an outpatient procedure in which tissue will be removed from the tumor using a needle. This tissue will then be analyzed by a pathologist — a doctor who reviews the results of the biopsy and provides information about the findings. A pathology report shows you the results of your biopsy.

Your pathology report is one resource that contains important information about your tumor, including whether it is cancerous. If cancer is present, your report will also assign a stage based on the cell structure in the tumor. It will also help guide your healthcare team in recommending an appropriate plan for you. 

What Will I Find in a Prostate Cancer Pathology Report?

Inside a pathology report is a general description of the sample size, the area of the tumor it was taken from, and a general explanation of what was found. This section of the report also includes:

  • A description of how the tissue appears to the pathologist without the aid of a microscope. This includes the sample size and weight, and the appearance and color of the tissue. 
  • How the cancer cells look under a microscope, which is a number called a Gleason Score. A higher number is a predictor of the cancer's aggressiveness (likelihood of growing and spreading). See below for a complete explanation about the Gleason Score. 
  • The number of core biopsy samples taken, if more than one. The core samples are taken when a needle is passed into the tumor and tissue is removed. The pathologist records the number of samples and the location of extraction. The locations where the samples are taken from are:
    • The apex, which is the area of the prostate that is located farthest from the bladder
    • The mid-zone, which is the middle of the prostate gland
    • The base, which is the area of the prostate closest to the bladder

Prostate Pathology Report Potential Findings 

A conclusion will be drawn after the pathologist examines the prostate tissue samples. The possible findings can be described in the following ways:

Benign Prostate Tissue

Of course, a benign tumor is the most-wanted conclusion. Any findings beginning with benign and followed with prostate tissue, prostate glands, or prostatic hyperplasia mean no cancer was found in the tissue sample. However, other conclusions may be drawn from this including:

  • An indication of the prostate gland enlargement which can be caused by an overabundance of prostate cells. This benign prostatic hyperplasia, as it is referred to, is common in older men and it is not cancer.
  • Acute or chronic inflammation of the prostate. This condition may increase PSA levels (detected in a blood test), but does not indicate cancer.
  • The oncologist may order a future biopsy if cancer is suspected based on results from a rectal exam or blood test to see if the cancer has progressed.
  • The report may contain other non-cancerous terms such as:
    • Atrophy: shrinkage of prostate tissue.
    • Focal Atrophy: shrinkage of a certain area.
    • Diffuse Atrophy: shrinkage of the entire prostate.
    • Adenosis: shows benign changes in the gland.

Atypical Findings

When the pathologist sees cells under the microscope that are not typical (atypical or suspicious of cancer), they might not conclude that cancer is not present. In cases such as this, the oncologist will err on the side of caution, which could possibly mean a follow-up biopsy. Urine, blood, and imaging tests may also be ordered.

  • Findings that show the presence of low-grade prostatic intraepithelial neoplasia means the cells look to be mostly normal.
  • Findings that show high-grade prostatic intraepithelial neoplasia means the pathologist will conclude that the cells are precancerous, which are cells that may become cancer over time. However, this indicates less risk for cancer than the "atypical or suspicious of cancer" conclusion.

Prostate Cancer

  • If the pathologist finds cancer cells, they will be graded with the Gleason System to determine severity. 
  • Ninety-five percent of prostate cancer is classified as adenocarcinoma. The specific type of cancer will be listed on the report.

What Does the Gleason Score Mean?

The Gleason Score is an indicator of the aggressiveness of the prostate cancer. The pathologist will identify the primary pattern (most common cell type) and the secondary pattern (next most common cell type) and those cells are given a grade. The Gleason System uses a scale of 1 to 5. 

  • Grade 1: close to normal tissue 
  • Grades 2 - 4: the cancerous tissue is between normal and very abnormal
  • Grade 5: the cancerous tissue and the pattern of growth are very abnormal

Gleason grades will be assigned independently to the primary and secondary cell pattern and then those two grades will be added together to find the final Gleason Sum. For example, 2+4=6. Since pathologists almost never assign scores 2-5, Gleason scores typically range from 6 to 10, with 6 being the lowest grade cancer.

The Gleason Score is used by oncologists to decide on the plan for treatment. This number is very important because it indicates the potential behavior of a cancerous tumor. The doctor will also take into consideration other factors such as MRI findings, rectal exam results, PSA level, and whether the cancer has spread beyond the prostate. 

Read more about the Gleason Score.

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