Understanding the Prostate Cancer Pathology Report

Pathology reports are filled with important information, but also a lot of terms you might not be familiar with. If your prostate pathology report has left you scratching your head, just know that you aren't alone. It's incredibly common for people to receive their prostate pathology report only to have more questions. Here is some information that may help make more sense of it. And remember, you can always reach back out to your doctor if you need further explanation.

The pathology report explains the results of your prostate biopsy and offers information about whether abnormal or cancer cells were found, and if so, how abnormal the cells appear. The data provided will help the prostate cancer specialist determine several things, including:

• The severity, or grade, of prostate cancer. This information helps determine the stage of cancer.
• The stage of prostate cancer.
• Whether cancer treatment is needed right away.
• If treatment is not needed now, the report will help the doctor decide how often you'll need prostate screenings in the future.

PSA Levels and Your Prostate Pathology Report

The PSA blood test is one type of test used to determine if there is a problem with how the prostate works. Sometimes it’s an indicator of prostate cancer, but it’s not a sure sign that cancer is present.

Higher levels (4.0 to 10.0 ng/mL) of prostate-specific antigen (a substance made by the prostate) in the blood may prompt your doctor to suggest a prostate biopsy. Your PSA levels, however, are not measured in the biopsy and will not be included in the report.

Keep in mind other conditions can raise your PSA level, including:

• An enlarged prostate
• An infection or inflammation
• If you're taking certain medications
• Natural aging

You may be asked to have a repeat biopsy if your PSA levels get significantly higher between checkups. PSA tests are also used after prostate cancer treatment (such as radiation or surgery) to see if the treatment was a success.

Negative Result on Your Prostate Pathology Report

If your pathology report indicates that there are negative findings, this is actually a good thing! A negative result means that prostate cancer wasn’t found in the tissue that was tested. The findings may also be referred to as 'benign", meaning there are no signs of cancer in the biopsied samples.

This information, coupled with a low PSA (prostate-specific antigen) test result, suggests that you may not need additional testing at this time. Your doctor will tell you if or when they would like to repeat a biopsy and/or a PSA blood test. Follow up with your physician to learn when you should get your next prostate cancer screening.

To rule out a false negative, especially if you’ve had any symptoms, you may have to do a repeat biopsy to check other areas of the prostate that were not tested in the first biopsy. The additional tests may be done as an extra precaution. In some cases, your physician may order additional tests such as urine, blood, or other lab tests so they can combine the information for a better diagnosis.

What If the Pathology Report Shows Atypical or Abnormal Findings?

The pathology report may indicate results that are referred to as atypical or not normal. These are called atypical. While this means that there are changes in your prostate cells, it doesn't always mean that it's cancer.

Prostatic Intraepithelial Neoplasia

One type of atypical finding is called prostatic intraepithelial neoplasia (PIN). PIN cells can be high- or low-grade.

• Low-grade PIN cells are closer to normal. They can occur in younger adult men, and about half of all men have PIN by age 50. Low-grade PIN cells do not increase prostate cancer risk. Because of their low significance in finding cancer, they are not included in pathology reports.
• High-grade PIN cells, which look more abnormal, are considered pre-cancer. They increase your risk of developing prostate cancer during your lifetime. Because of this potential risk, your doctor will usually want to do another prostate biopsy or other lab tests. Further testing is especially important if high-grade PIN cells are found in different parts of your prostate.

Atypical Small Acinar Proliferation

Atypical small acinar proliferation (ASAP) is when there are abnormal cells that look cancerous, but there are too few of them to make an official diagnosis. To rule out prostate cancer, your doctor will likely schedule you for another biopsy in a few months.

Proliferative Inflammatory Atrophy

Prolific inflammatory atrophy (PIA) is when the prostate cells look smaller than normal or there are signs of inflammation. While this is considered an abnormal finding, it is not cancer. Keep in mind; PIA can lead to high-grade PIN or even lead to prostate cancer in the future.

Understanding a Positive Result

The pathology report will determine if the biopsy sample is positive or negative for prostate cancer. If it is positive for cancer, meaning that cancer has been found, your next step will be getting a treatment plan in place. Treatment plans often include active surveillance that requires more frequent visits with your doctor but does not require a procedure or other active measures to reduce or remove the cancer. You'll go to a cancer specialist, also known as an oncologist, for your treatment plan.

Prostate Cancer Grading

The next thing that a pathology report will explain is the grade of your cancer. The grade is based on how abnormal the cells look under a microscope. Grading is used to create a customized treatment plan and determine how often you should have testing or screenings in the future.

It's important to understand how grading works. Grade 1 means the cells appear to be normal prostate tissue. Grade 5 means cells look very abnormal. However, Grades 2, 3, and 4 have different features and levels of severity. Most prostate cancer diagnoses are grade 3 or higher.

Prostate Cancer Growth

Keep in mind; the more abnormal the cells look, the more likely it is to grow and spread to other areas of the body. Therefore, knowing the grade could help determine how aggressive your treatment should be.

Oncologists use two methods to grade prostate cancer. The Gleason system is the traditionally used method with scores ranging from 2 to 10. The Grade Groups system is a newer method that grades cancer from 1 to 5. A pathology report may use one or both methods.

Gleason Scores

It's not unusual for prostate cancer to have different grades in different areas of the prostate. The two different grades are referred to as primary and secondary grade patterns. These numbers reflect the two areas that make up the majority of the cancer cells.

Consider this example for understanding Gleason scores:

If most of your cancer is grade 3 and a smaller amount is grade 4, your Gleason score is listed as 3+4=7. The first number listed (3, in this example) means most of the cells are that grade. A Gleason score of 6 or lower is considered low-grade; a score of 7 means an intermediate grade; an 8 to 10 score is high-grade cancer.

Read our blog to learn more about why is a Gleason score so important to prostate cancer patients.

Grade Groups

Our oncologists use Grade Groups to help decide if and when treatment is appropriate. Here is a breakdown of the grade groups.

• Grade group 1 is the same as a Gleason score of 6 or less.
• Grade group 2 is the same as a Gleason score of 3+4=7.
• Grade group 3 is a Gleason score of 4+3=7.
• Grade group 4 is a Gleason score of 8.
• Grade group 5 is a Gleason score of 9 to 10.

Other information that may be included in your pathology report includes:

• Number of samples taken
• Number of samples that contain cancer
• Percentage of cancer in each sample
• Location of cancer (left, right, or both sides of the prostate)
• Whether there is perineural invasion which means that cancer cells are seen surrounding or near a nerve fiber within the prostate. If this is found it means that it’s likely prostate cancer has likely spread outside the prostate. a higher chance that the cancer has spread outside the prostate.

Types of Prostate Cancer

One of the most helpful pieces of information on a pathology report is learning the type of prostate cancer that was found. Your oncologist will also consider the cancer grade (how abnormal the cells are) and stage of prostate cancer (size of cancer and whether it has spread).

Types of prostate cancer:

• Acinar adenocarcinoma develops in the cells lining the prostate. This is the most common form of prostate cancer that is diagnosed.
• Ductal adenocarcinoma starts in the cells lining the prostate grows and tends to grow and spread rapidly.
• Transitional cell cancer begins in the lining of the urethra tubes in the bladder and then spreads to the prostate.
• Squamous cell cancer starts in the cells covering the prostate and tends to grow and spread more quickly than other forms of prostate cancer.
• Small cell prostate cancer starts in neuroendocrine cells.

Help with Understanding Your Pathology Report

Cancer Care Centers of Brevard is committed to making sure each patient has a clear understanding of their prostate cancer diagnosis. If you've recently been diagnosed with prostate cancer and would like help with understanding the specifics of your prostate cancer pathology report, we are happy to assist you. Contact us today to schedule your next appointment.

Categories: Prostate Cancer