Stephan L. Werner, M.D., F.A.C.S.

What if the biopsy is positive, (shows that cancer is present)?

   When prostate cancer has been found, it is not a death sentence!   Many patients can be cured of prostate cancer if it has been found early enough, (that's why we look hard and recommend regular examinations and PSA tests).  Even if the cancer is not curable many patients can be treated, the cancer slowed down, and they can live for years.  Before we can even give a prognosis or plan treatment, the urologist must take into account many factors and perhaps do some more tests.  The first factors to evaluate are the Grade and Stage of the cancer.

PIN or Prostate Intraepithelial Neoplasia

    PIN is a non cancerous  cell abnormality that is frequently associated with prostate cancer.  It requires careful evaluation.

Atypia

    Sometimes atypical cells are found.  These abnormal cells are usually too few in number, or are not "bad" enough to be diagnosed as cancer.  They are followed in a similar fashion to PIN   

Grade or Gleason Grade

   When the pathologist looks at the biopsy he grades the cancer by comparing the appearance of the cancer cells to the appearance of normal prostate tissue.   The grades go from Grade 1, almost normal, to Grade 5, very abnormal.  

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    The Pathologist then adds the results from the two greatest areas of cancer and gives a report, for example, (3+2=5).  Therefore positive biopsies run from Gleason grade 2, which has a relatively good prognosis, to Gleason grade 10, which does not.  The vast majority of biopsies are Gleason grade 6, or moderate.

The Stage of a cancer refers to how far it has progressed.   There are several different staging systems but the most commonly used is A, B, C, D.  Within each stage there are sub- stages:

Stage A describes a cancer that is only found by elevated PSA and biopsy, or at  surgery for obstruction. It is not palpable on DRE.  It is localized to the prostate. This type of cancer is  usually curable, especially if it is a relatively low Gleason grade. 

Stage B Cancer refers to a cancer that can be felt on rectal examination and is limited to the prostate.  Other tests, such as bone scans or CT/MRI scans, may be needed to determine this stage, especially if the PSA is significantly elevated or the Gleason grade is 7 or greater.  Many Stage B prostate cancers are curable.

Stage C Cancer has already spread beyond the capsule of the prostate into local organs or tissues, but has not yet metastasized or jumped to other sites.  This stage  is determined by Digital Rectal Exam, or CT/ MRI scans,  and/or Sonography. The bone scan, and , if done, the Prostascint scan are negative.   Some Stage C cancers are curable.

Stage D Cancer has already spread, usually to distant lymph nodes, bones or other  sites.  This is usually determined by bone scan, Prostascint scan or other studies. Stage D cancer is not curable but is treatable

Risk Status

   There has been discussion recently about a slightly different classification for planning of therapy of apparently confined prostate cancers:  Low, intermediate or high risk.

    Low risk comprises those prostate cancer that are low in volume, Stage A or B1/B2, with a Gleason Grade of 6 or less, and a PSA less than 11.

    Intermediate risk requires Stage B3 or Gleason Grade 7 or PSA greater than 10.

    High Risk includes those cancers Gleason grade 7 or above and PSA greater than 10

Stephan Werner, M.D., F.A.C.S.

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Greenbelt - Bowie - Laurel     Maryland

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Rev:03/08