A complete pathology report will contain a description of each core sample that includes:
- The location the sample was taken from (only available if the Urologist puts each sample in a separate, labeled container)
- A description of the core sample including length, diameter, color
- An indication of the type of any cancer found (such as adenocarcinoma) and the percent (or mm) of the core that is cancer
- An indication of the primary and secondary Gleason grades and the percent for each grade
- An indication of perineural invasion if present which can be a risk factor of tumor spread outside the prostate
- An indication of High Grade PIN (prostatic intra-epithelial neoplasia) if present which may be a precursor to prostate cancer
- An indication of inflammation or prostatitis if present which may explain an elevated PSA and could be a precursor to PIN
- Any other abnormal finding such as atypia, atrophy or benign prostatic hyperplasia (BPH)
- The name and signature of the Pathologist who reviewed the slides
What is your Gleason score?
Gleason grading is a very important predictive factor in assessing your prostate cancer risk. The Gleason score is determined by the pathologist by examining the biopsy tissue under a microscope. It is the sum of 2 Gleason grades which range from 1 to 5. Grade 1 represents non-aggressive cancer that looks similar to normal prostate cells. Grade 5 indicates highly aggressive, poorly differentiated cell patterns. The most common grade observed in the sample is placed first in the sequence of the two numbers. The second grade is different if a secondary pattern was observed. Your Gleason score should be reported with both grades (ex. 3+4=7). If only a Gleason score (Ex. 7) is given, you should ask for the Gleason grades.
In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns. This might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall. When this occurs, it is reported separately as a tertiary pattern.
Gleason grade 3 is most common and usually indicates a slow growing cancer of low risk.
Gleason grades of 4 or 5 are the primary indication of a high risk cancer with higher probability of extending beyond the prostate.
Because the Gleason grade/score is a critical factor and often understated, a patient should consider having the slides/tissue blocks reviewed by a pathologist who is an expert in prostate cancer.
For more information to understand your biopsy, see:
What is the significance of your number of cores positive?
A prostate biopsy is typically 12-14 cores. Your biopsy report should list each core with the location, and if positive, the Gleason grades and the percent of cancer. There is a higher risk that the cancer is not confined to the prostate when:
- Multiple cores are positive
- The percent of cancer in the cores is higher
- More cores have higher Gleason grades
- Positive cores are found on both sides of the prostate (bilateral)
What is the significance of perineural invasion (PNI)?
PNI is reported when the pathologist detects cancer spreading along the nerves within the prostate. These nerve pathways could provide a means for cancer cells to escape the prostate into the neurovascular bundles. While this is a concern, experts disagree as to whether this translates to an increased risk of cancer outside the prostate.
What other findings provide prognostic information?
An expert pathology review can also provide valuable genetic information like ploidy, bcl2, EZH2, Ki67, MIB-1, p27, and p53. The use of genetic markers is only beginning to evolve and provide the hope of more individualized risk analysis and treatment selection.