More on Diagnosis:
Biopsy to determine morphological change of prostatic cells via histologic assessment.
The Gleason scoring system, the single most important prognostic factor for long-term survival, is used to rate the aggressivity of the cancer--the level of disorganization and the speed of growth:
- Scale of 2-10 where lower scores indicate less aggressive, more normally differentiated prostatic cells.
- A higher Gleason score usually means that the tumor is fast-growing and may have already metastasized.
Imaging: CT, transrectal ultrasound, MRI
Notes:
- What does cancer look like? Very simply, normal prostate is organized tissue while cancer is disorganized.
- Gleason score of 2-4 = minimal risk of dying of PC in 15 years, whereas men having tumors of grades 8-10 face a 60-87% risk of dying in the next 15 years.
- Pathologist identifies the most predominant pattern in the specimen and give it a rating from 1-5. Then identifies the second more predominant pattern and also rates it. Then the pathologist adds up the scores.
- Men are often understagedódeemed to have less advanced and less aggressive cancer than they usually have. The odds of understaging and metastasis go up as tumor size, PSA level and Gleason score rise in concert.