Prostate Cancer Testing & Diagnosis
What is Prostate Cancer Screening?
The American Cancer Society recommends men start prostate cancer screening by age 50 if they aren't at high risk of prostate cancer. A family history or the presence of risk factors may result in screenings starting sooner.
When Is the Right Time for a Prostate Cancer Screening?
There are two common components in prostate cancer screening:
PSA Blood Test
The PSA (prostate-specific antigen) blood test looking at the levels of PSA in the blood. A high PSA levels can be a sign of prostate inflammation, but high levels can also be a sign of cancer. It's common for your doctor to have you retest your PSA in 6 months to see if it continues to rise. If so, additional testing might be done.
A Digital Exam of the Rectum
The rectal exam involves "feeling" for problems with the prostate. The doctor will use a glove-protected finger to feel for your prostate by gently pressing against the interior wall of the rectum. The doctor is looking for abnormalities like lumps, lumpy spots, or hardness. If found, imaging may be the next step.
Prostate Cancer Diagnosis
While a digital exam and PSA tests may signal something is up with the prostate, it doesn't always mean that cancer is present. To make a diagnosis, further tests may be performed. Two of these tests are the transrectal ultrasound and biopsy. An ultrasound involves inserting a thin probe into the rectum to get a digital image of the prostate. A biopsy is usually performed by inserting a needle into the rectal wall to collect cells for testing. If cancer cells are found, further steps are taken to get an accurate look at the cancer.
Understanding the Prostate Cancer Pathology Report
The Gleason Score and Prostate Cancer Grading
After a prostate cancer diagnosis, Gleason scores are assigned to explain how much the tissue differs from healthy tissue. The less-aggressive types of cancer cells can look closer to healthier tissue. More aggressive tissue looks much more different under a microscope, but less aggressive types are more common.
Gleason scores are assigned by using a grading system of between 3 and 5. Cells that look more like healthy cells get a lower score. Cancer cells from two locations in the prostate are examined. The two scores are added together to get a score from 6 to 10. For example, one cell sample receives a score of 3, and another receives a score of 5. The total score would then be 8.
Sometimes, just the combined score doesn't give the most accurate look. The number assigned from the part of the prostate where the most cancer cells were found can be more important than the second number. For that reason, once Gleason scores are determined, the pathologist will simplify the score into a grade group for further clarity. For example:
- Gleason score of 6 (cells look similar to healthy cells) = Grade Group 1
- Gleason score of 4 and 3 (somewhat similar to healthy cells) = Grade G2
- Gleason score of 3 and 4 (somewhat similar to healthy cells) = Grade G3
- Gleason score of 8 (very different from healthy cells) = Grade G4
- Gleason score of 9 or 10 (even more different from healthy cells) = Grade G5
Grade group 1 is going to be a slower-growing form of cancer, while grade group 5 is more likely to grow faster.
Why Is a Gleason Score So Important to Prostate Cancer Patients?
After a Prostate Cancer Diagnosis: What to Expect
A urologist is often the doctor who orders the ultrasound and performs the biopsy to determine if prostate cancer is present. If it is, there are some choices to make based on the Gleason score and how much the cancer has grown. The extent of cancer is referred to as the stage of cancer.
Learn more in our section called: What to Expect Next After a Prostate Cancer Diagnosis.
The prostate cancer doctors at Cancer Care Centers of Brevard work with you to create a personalized treatment plan for prostate cancer based on your specific situation. Find an oncologist at one of our cancer centers located throughout Brevard County, including Melbourne, Merritt Island, Palm Bay, Rockledge, and Sebastian, FL.