If you recently had a prostate biopsy, your doctor will receive a prostate pathology report. It includes the findings of the tests run on the samples of tissue. It’s the best way to determine if prostate cancer is present. If it is, the report will also play a role in deciding the next steps. For some men, treatment may need to begin; for others, waiting may be the best recommendation before starting treatments.
The pathology report includes medical terms and information you may not know. Let’s look at some common questions patients ask after receiving the biopsy results.
What Does a Negative Result Mean?
A negative result on your pathology report is good news! This means that the cells appeared normal, and no prostate cancer was found in the tissue samples that were tested. If you have a negative or benign result, your elevated PSA level could be caused by another condition. Your doctor will determine whether there needs to be additional testing or treatments for non-cancerous prostate conditions.
If your PSA is holding steady, even if it’s slightly elevated, your doctor may suggest you follow a regular screening plan and test your PSA every year. If PSA starts to rise, you may need another biopsy or further testing.
What Do Abnormal Pathology Findings Mean?
Abnormal or atypical findings in a prostate biopsy pathology report mean they found at least some changes in your prostate cells. However, this does not mean you have prostate cancer. There are several categories of atypical findings that could be on your prostate pathology report:
- Prostatic intraepithelial neoplasia (PIN) can be low-grade or high-grade.
If high-grade PIN cells are found, they will be included in the pathology report. These cells are considered precancerous. They indicate a risk of developing prostate cancer in the future. Your oncologist may recommend another biopsy in the near future and careful tracking of your PSA levels if there are high-grade PIN cells in several areas of your prostate.
- Proliferative inflammatory atrophy (PIA) means your prostate cells look smaller than normal, or there are signs of inflammation. You do not have cancer, but you have a higher risk of developing prostate cancer in the future.
- Atypical small acinar proliferation (ASAP) means some abnormal cells were found, and they appear cancerous. However, there aren't enough cancer cells present to make an official prostate cancer diagnosis. You are likely to need another biopsy in a few months.
With atypical results, prostate cancer treatment planning is not usually required. But careful monitoring is recommended.
What Does it Mean by a Positive Result on a Prostate Pathology Report?
A positive biopsy report confirms the presence of cancer cells in the prostate. If the cells are not highly abnormal, active surveillance may be the recommended approach. Active surveillance involves regular monitoring to track further changes in your prostate cells. However, if the cells are highly abnormal, treatment may need to begin right away. Your urologist, who is typically the doctor who performed the biopsy, may suggest surgery to remove the prostate. While this may be necessary, many men can be successfully treated for prostate cancer without removing their prostate.
Related Reading: Treating Prostate Cancer: Know Your Options Beyond Surgery
The Gleason score in the pathology report plays an important role in determining when to start treatment and which types of treatment are necessary.
Gleason Score and Grade Groups: What Do They Mean?
Your pathology report will likely include a Gleason score and a grade group, describing how much the cancer cells have grown and how likely the cancer is to spread quickly.
Gleason Score
The two most predominant cell patterns taken from multiple areas of the prostate will be graded on a scale of 1 to 5. These two are added together to provide a Gleason score. The most predominant pattern is placed first, followed by the second-most predominant pattern. This means your Gleason score will look something like 3+4=7. Anything less than a 6 is not considered cancer.
Treatment might be recommended for a score of 7 if the results are a 4+3. A score of 8 or more usually means some type of treatment will begin.
Related reading: A Gleason Score of 7: Why is it So Important?
If you have a repeat biopsy in the future, an increased Gleason score will be one indicator used to decide if it’s time to start treatment.
Prostate Cancer Grade Groups
Grade groups are another tool that is similar to the Gleason score. This system measures the severity of your cancer and assigns it a score from 1 to 5. Grade 1 means your prostate cells look normal. Grade 5 means the cells look highly abnormal. The Gleason score can be correlated to a grade group.
Low grade - slow growing
- Grade 1: This is usually a Gleason score of 6 or less
Intermediate grade - moderate growth rate
- Grade 2: This is typically a Gleason score of 3+4=7
- Grade 3: This is typically a Gleason score of 4+3=7
High grade - aggressive growth rate
- Grade 4: Gleason score of 8
- Grade 5: Gleason score of 9 or 10
A higher Gleason score and grade group mean that treatment is more urgent and additional testing may be needed to determine the cancer’s stage.
What Else Is Included in the Prostate Pathology Report?
Your pathology report may also include the following:
- Percentage of cancerous cells in the sample
- Number of samples taken
- Number of samples that contain cancer
- Location of cancer (left, right, or both sides) in the prostate
- The type of prostate cancer (although this may not be included in all biopsy reports)
Learn More About Your Prostate Cancer Treatment Options in Colorado
The prostate cancer specialists at Rocky Mountain Cancer Centers will help you understand your pathology report, grade, and best recommendations for treatment. Usually, a radiation oncologist will lead the treatment plan for prostate cancer since radiation therapy is one of the most effective treatment options, often allowing the patient to keep the prostate intact.
Our prostate cancer specialists are available at locations throughout Colorado’s Front Range, including Boulder, Colorado Springs, and Denver, Colorado. Request an initial consultation or a second opinion to create the right treatment plan for you.
