Diagnosing Prostate Cancer
Talk with your primary care physician or urologist and get a personalized assessment of when you should start screening. Depending on family history, race and other risk factors, starting as early as age 40 may be the right choice.
How should I be screened for prostate cancer?
Talk with your primary care physician or urologist and get a personalized assessment of when you should start screening. Depending on family history, race and other risk factors, starting as early as age 40 may be the right choice. Black men are at highest risk for prostate cancer in the U.S. They also are 2.4 times more likely to die from the disease.
The most common screening involves a blood test called a prostate specific antigen (PSA) test that measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer, though levels also may be elevated in other conditions that affect the prostate.
How is prostate cancer diagnosed?
If your PSA test is abnormal, it doesn’t necessarily mean you have
prostate cancer. Your primary care doctor or urologist may recommend an MRI of the prostate or a biopsy to find out if you have prostate cancer. During a biopsy
procedure, usually performed by a urologist, a small piece of tissue is
removed from the prostate. A pathologist will examine the tissue under a microscope to see whether
cancer cells are present.
What do grades and Gleason scores mean?
After prostate cancer has been diagnosed, tests may be conducted to find out whether the cancer has spread within the prostate or to other parts of the body. These tests and procedures may include scans or a further biopsy.
A pathologist will look at tissue samples from the biopsy under a microscope to grade the cancer cells based on how they look compared with normal cells. The grade gives your provider an idea of how fast the cancer may grow and spread.
Grade 1: The cancer cells appear similar to normal prostate tissue.
Grades 2 to 4: The cancer cells look normal to very abnormal.
Grade 5: The cancer cells look very abnormal.
A grade is given to each of the two parts of the prostate that have the most cancer cells. The grades from the two areas are added together to provide the Gleason score (between 2 and 10).
Gleason scores are used to put prostate cancers into three groups. The higher the Gleason score, the more likely the cancer is to grow and spread:
- Gleason score of 6 or less is low grade or well differentiated cancer.
- Gleason score of 7 is intermediate grade or moderately differentiated cancer.
- Gleason score of 8 to 10 is high grade or poorly differentiated cancer.
Recognizing that cancers with the same Gleason score may have differences, some healthcare providers utilize a newer system that divides prostate cancers into five grade groups:
- Grade group 1 = Gleason score of 6 or less
- Grade group 2 = Gleason 3 + 4 = 7
- Grade group 3 = Gleason 4 + 3 = 7
- Grade group 4 = Gleason 8
- Grade group 5 = Gleason 9 or 10
What are the stages of prostate cancer?
The TNM system from the American Joint Committee on Cancer is the most common system for staging prostate cancer using values for tumor (T), nodes (N) and metastasis (M). The stage refers to the size of the cancer and whether it has spread.
Stage I
The cancer is only inside the prostate. It is grade group 1, the PSA is less than 10, and it meets one of these criteria:
- The tumor can't be felt by digital rectal exam (DRE) or seen on an ultrasound.
- The tumor can be felt by DRE or seen on an ultrasound. It was found in one-half or less than one-half of one side of the prostate.
- Surgery to remove the prostate determined that the cancer was contained inside the prostate.
Stage II
- Stage IIA: The cancer is located within the prostate, it is grade group 1, and meets one of these criteria:
- The tumor can't be felt by DRE or seen on an ultrasound. The PSA is between 10 and 20.
- The tumor can be felt by DRE or seen on an ultrasound. It was found in one-half or less than one-half of one side of the prostate. Surgery to remove the prostate determined that the cancer was contained inside the prostate. The PSA is between 10 and 20.
- The tumor can be felt by DRE or seen on ultrasound. It is located in more than one-half of one side of the prostate or in both sides of the prostate. The PSA is less than 20.
- Stage IIB: The tumor has not spread beyond the prostate. It may or may not be felt by DRE or identified on an ultrasound. The grade group is 2. The PSA is less than 20.
- Stage IIC: The tumor has not spread beyond the prostate. It may or may not be felt by DRE or seen on ultrasound. The grade group is 3 or 4. The PSA is less than 20.
Stage III
- Stage IIIA: The tumor has not spread beyond the prostate. It may or may not be felt by DRE or identified on an ultrasound. The grade group is 1 to 4. The PSA is 20 or higher.
- Stage IIIB: The tumor has spread to the seminal vesicles or to nearby tissues such as the bladder, rectum or the wall of the pelvis. It has not spread to nearby lymph nodes. The grade group is 1 to 4. The PSA can be any level.
- Stage IIIC: The tumor may or may not have spread beyond the prostate into nearby tissues. It has not spread to nearby lymph nodes. The grade group is 5. The PSA can be any level.
Stage IV
- Stage IVA: The tumor may or may not have spread beyond the prostate into nearby tissues. It has spread to nearby lymph nodes, but not to other areas of the body. It can be any grade group, and the PSA can be any level.
- Stage IVB: The tumor may or may not have spread beyond the prostate into nearby tissues or lymph nodes. It has spread to other areas of the body such as distant lymph nodes, bones or other organs. It can be any grade group, and the PSA can be any level.
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