Biopsy
A biopsy is an analysis of prostate tissue samples taken from the patient and is necessary to diagnose prostate cancer. Researchers hope to make this process more accurate and less painful.
A tiny needle is used to take cylindrical core samples, about 1/2-inch long and 1/16-inch wide, from the prostate. It is done in about 15 to 30 minutes with a “biopsy gun” tool. Doctors usually take anywhere from 6 to 18 core samples, including a minimum of three from the left side of the prostate and three from the right.
Samples are sent to a pathologist to determine whether there are any signs of cancer cells, and if so, how advanced the cancer may be. The pathologist will determine whether cells are normal, suspicious or malignant (cancer).
Gleason Score Shows Added Benefit for Guiding Treatment
An extra step to the standard prostate cancer test may be just what the doctor ordered. Doctors use the Gleason test - named for the physician who developed it - as a tool to evaluate the severity of a prostate cancer tumor and also how aggressively it should be treated.
For the Gleason test, doctors take a biopsy of the cancer and look at the level of disorder displayed by cells in the two largest sections of the sample - scoring them from 1 (less disorderly) to 5 (more disorderly). The less normal the normal tissue appears, the more aggressive the cancer is. The two numbers are then added together to come up with the Gleason score. For example, a score of 7 calls for treatment such as radiation therapy, but a higher score indicates an even more dangerous tumor.
After a biopsy, a pathologist evaluates the pattern of abnormal cells in the tumor sample and rates them on a scale of 1 to 5, with 1 being the healthiest, 5 being the most cancerous. Gleasons are the sum of two scores, representing the first and second most-common pattern seen.
The lowest possible Gleason score is 2 (1+1), indicating few cancerous changes are present; the highest is 10 (5+5), meaning the cancer is advanced.
Most Gleason scores fall in the middle; and some men with low Gleason scores have cancer that spreads quickly, while some with high scores don't. It's also a single snapshot fixed in time.
