PSA (Prostate Specific Antigen) Test:
This test assesses the amount of a protein known as PSA, which is produced by the prostate gland. As men age, the level of this protein can rise and can be detected through a blood test.
While PSA tests are useful, they are not sufficiently precise to be relied upon solely. Elevated levels can occur in individuals without prostate cancer, and various conditions can also cause an increase in PSA levels.
DRE ( Digital Rectal examination)
A Digital Rectal Examination (DRE) is a quick and simple procedure. During the exam, a doctor will insert a gloved, lubricated finger into the rectum to check if the prostate gland is enlarged or has any abnormalities.
If the prostate gland is cancerous, it may feel hard, uneven, or have an irregular surface, whereas a healthy prostate typically feels smooth and even.
A DRE can also provide information about the extent of prostate involvement if cancer is present. This assists healthcare professionals in determining the appropriate treatment if prostate cancer is detected.
The examination is generally painless, although it may cause slight discomfort.
Visiting the urologist :
If a PSA blood test or DRE yields abnormal results, or if there is a strong suspicion of prostate cancer, men will be referred to a hospital specialist known as a urologist.
Prostate Biopsy :
A urologist might suggest a biopsy, which involves taking samples of prostate tissue, performed under either local or general anesthesia.
Prostate biopsies can be done by inserting an ultrasound probe into the rectum to locate the prostate gland and then extracting small tissue samples. Alternatively, biopsies can be conducted using a transperineal approach, where samples are taken through the area between the rectum and the scrotum, often necessitating general anesthesia.
Nowadays, a special type of MRI scan called a multiparametric MRI is used to examine the prostate before performing a biopsy. This technique allows for the identification and targeting of specific areas within the prostate that may contain cancerous cells.
Post Prostate Biopsy:
As with any surgical procedure, a prostate biopsy carries a slight risk of infection. To prevent infection, men may be prescribed antibiotics for several days following the procedure. The prostate will be inflamed and swollen, leading to some initial discomfort which should gradually subside.
It is common to notice some blood in the urine and semen after a biopsy, which can persist for 2-4 weeks.
It is advisable to avoid strenuous activities, such as heavy lifting or gardening, for about five days post-biopsy to prevent bleeding and facilitate the healing process.
In rare cases, the prostate may become so swollen that urination becomes difficult. If this occurs, the medical team will insert a catheter, a special drainage tube, until the swelling decreases.
Biopsy Results:
The tissue samples taken from the prostate will be sent to a laboratory for cancer examination. This analysis is conducted by scientists known as histopathologists. They will examine the tissue under a microscope to detect any cancerous cells.
What is Gleason Score:
If prostate cancer is detected, it will be evaluated using the Gleason grading system, which is the standard method for classifying prostate cancer. This system provides doctors with an accurate understanding of how aggressive or concerning the cancer might be.
Cancerous cells appear different from normal cells under a microscope. Normal cells are typically uniform in size and appearance, whereas cancerous cells may lack a clear shape and are difficult to differentiate from one another.
The Gleason grading system assigns a score between 3 and 5 based on the cells’ appearance, indicating the level of abnormality. For instance, Grade 5 cells appear more irregular compared to Grade 3 cells.
The process involved in determining a Gleason Score:
The histopathologist will follow these steps to assign an accurate Gleason Score to your tissue sample:
– Identify the predominant type of cell structure present, assigning a score between 3 and 5 based on the appearance of cancer cells.
– Evaluate the second most prevalent type of cancerous cell using the same grading scale.
– Combine the two scores to determine the total Gleason score out of 10 (for example: 3+3 equals 6 out of 10).
Assessing your Gleason score:
Gleason score | Type of cancer |
6 | Slow progression |
7(3+4 or 4+3) | Moderate grade |
8(3+5,4+4,5+3) | More aggressive |
9(4+5 or 5+4) | More aggressive |
10(5+5) | More aggressive |
Gleason score and risk groups:
Gleason score | Grade Group Number | Risk Profile |
3+3 | Grade Group 1 | Low Risk |
3+4 | Grade Group 2 | Intermediate Risk |
4+3 | Grade Group 3 | Intermediate Risk |
3+5 | Grade Group 4 | High/Very High |
4+4 | Grade Group 4 | High/Very High |
5+3 | Grade Group 4 | High/Very High |
4+5 | Grade Group 5 | High/Very High |
5+4 | Grade Group 5 | High/Very High |
5+5 | Grade Group 5 | High/Very High |