A biopsy of the prostate involves obtaining a representative sampling of 12-16 small cores of tissue; however, it can give you a clue as to the nature of the cancer in the entire gland and help in your decision-making process. The two most important features of a path report showing prostate cancer are the grade, or Gleason’s score, and the number and percentage of positive cores, or volume of disease. The Gleason’s score is indicative of the potential aggressiveness of your cancer and is determined by a pathologist, who evaluates the two worst areas (highest grades) of your specimen and assigns each area a number between 1 and 5. The most common Gleason’s grade found in positive biopsies is 6, or a 3+3, which is referred to as moderate grade. A Gleason’s score of 7, which represents a 3+4, or above is considered high-grade prostate cancer. The score is important because the higher the grade, the more aggressive and unpredictable the cancer. In my opinion, a higher grade should make a patient lean toward a more aggressive treatment.
Volume of disease, or percentage of the biopsy cores that contain cancer, particularly if present on both sides of the prostate, is also important as it may indicate the amount of disease in the entire gland. So, low grade and low volume are good things, and high grade and large volume are not as good. Knowing this helps you make a decision regarding your treatment. If you had a choice between having a low grade or low volume, low grade is much better. High grade (Gleason’s score 7 or greater) is unpredictable, more aggressive, and accounts for most of the deaths attributed to prostate cancer. If you have a high Gleason’s score, you may not have the same results as your friend who had a low Gleason’s score and did well with a particular treatment. If you are basing your decision on what he did without knowing the specifics of his biopsy, you are making a decision based on a flawed premise.
The chart that follows is a simplified overview of the various combinations of Gleason’s score and volume of disease seen in prostate biopsies. What I hope you will learn to do is to take each of the issues related to you and your cancer and, for each, evaluate which treatment is best suited to you. As it applies to Gleason’s score and volume of disease, use the chart below to determine which grid most applies to your biopsy report. If you fall into the favorable parameters group, low Gleason’s score and low volume of disease, and you want to purse a less aggressive treatment, it is reasonable to do so. However, if you are in the unfavorable parameters group, you may need to put aside your concerns about the ease of treatment or impact on your daily life in favor of choosing the more aggressive therapy with the most options for cure. (You can do radiation after surgery, but it is difficult to do surgery after radiation.)You need to know the parameters of your biopsy and the significance of each to help you in your decision. As you progress in your journey, you will begin to consider all the parameters, in addition to the specifics of your biopsy; which parameters you ultimately weigh most heavily in your decision can be determined only by you.
In addition to the biopsy specifics, the most important of which is the Gleason’s score and the number of cores positive, you need to be aware of your PSA and the findings of your rectal exam. (A palpable nodule implies capsular extension and this may impact your decision making process.)