If your doctor notices your PSA levels are continuing to rise, or the digital exam causes concern, further testing may be recommended. There may be other tests to rule out non-cancerous conditions such as a urine test to check for blood or infection. Additionally the doctor would like to look at the prostate and potentially examine the cells within the prostate. This is done with:
Transrectal Ultrasound
The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
Transrectal Biopsy
A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.
Understanding the Results of Your Prostate Biopsy
The tissue removed during a prostate biopsy is sent to a pathologist for further analysis and testing. Pathologists are doctors who perform various tests on the tissue to see if the cells are cancerous, precancerous, or normal. Your pathologist will then summarize the results of the tests and their findings in a prostate biopsy pathology report that details the results and outlines the findings. This report is a critical part of determining a treatment plan for each patient.
The report discusses any abnormal, atypical, or cancerous cells that were found. Pathology reports can differ on some of the specific information they contain based on each pathologist. Still, there are a few key components that you may want to review.
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Gross Description - this is the pathologist’s initial study of the tissues without using a microscope.
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Microscopic Description - this portion of the report is also a visual study of the tissue. This section covers what the pathologist saw when the tissue was under magnification.
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Gleason Score - this section outlines a specific method of understanding how fast cancer may grow. That results in a grade.
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Cell structure - your pathologist will also classify cancer based on the cell structure. This section is typically broken into three grades and identifies how well cancer cells are differentiated from each other. This can result in determining the type of prostate cancer that’s present.
While it is likely that your medical team will have copies of your report, you should request your own. Take your time in reviewing the report and ask questions about parts that are not clear.
If Prostate Cancer is Found
If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.
