How to Read a Prostate Cancer Pathology Report

6 min read

How to Read a Prostate Cancer Pathology Report

If you’ve just received the results of a prostate pathology report from your doctor, you may have questions that you didn’t think about when you first spoke with your doctor.  While you can certainly always check back with your doctor for more clarification, we’ll walk you through the information that is included in a prostate pathology report. 

Understanding Your Prostate Pathology Report

A pathology report describes the findings of a prostate biopsy. It provides information about whether abnormal cells or cancer were found, and it will be used to:

  • Determine the stage and severity of any cancer that was found
  • Determine if prostate cancer treatment is needed and if so, what types. 
  • Decide how often you’ll need future prostate screenings

Prostate Cancer Screening Before a Biopsy

The PSA blood test is used to screen for prostate cancer. High levels (between 4.0 to 10.0 ng/mL) of prostate-specific antigen, a substance made by the prostate, in the blood is a strong indicator that cancer is present. However, other conditions can raise your PSA level, including an enlarged prostate, an infection, or inflammation, if you’re taking certain medications or getting older. PSA levels normally go up as you age, even if you have no prostate problems.

Based on your PSA level, your urologist may recommend a prostate biopsy to confirm or rule out cancer. PSA tests are also used after prostate cancer treatment (such as radiation or surgery) to see how well your treatment worked. 

Negative or Benign Findings in Your Prostate Pathology Report

The report will indicate one of three levels of prostate health. A negative finding means there was no cancer or unusual tissue in your prostate. This finding is called ‘benign,’ meaning there are no signs of cancer at this time. And, if your PSA (prostate-specific antigen) screening test indicates a low likelihood of cancer, you probably won’t need any more tests for a while. Your doctor will discuss how often you should be screened for prostate cancer. 

You may have a repeat biopsy to check the parts of your prostate that were not biopsied the first time. This precaution can rule out a false-negative result. False-negative means cancer cells or other suspicious tissue were missed when biopsy samples were taken. Your doctor may order urine, blood, or other lab tests to gather more information. 

Atypical or Abnormal Findings in Your Prostate Pathology Report

The pathology report may indicate results that are not normal. These are called atypical. This means there are changes in your prostate cells, but it does not necessarily mean cancer has been found. 

Prostatic Intraepithelial Neoplasia

One type of atypical finding is called prostatic intraepithelial neoplasia (PIN). PIN cells can be high- or low-grade. 

  • Low-grade PIN cells are closer to normal. They can occur in younger adult men, and about half of all men have PIN by age 50. Low-grade PIN cells do not increase prostate cancer risk. Because of their low significance in finding cancer, they are not included in pathology reports. 
  • High-grade PIN cells, which look more abnormal, are considered pre-cancer. They increase your risk of developing prostate cancer during your lifetime. Because of this potential risk, your doctor will usually want to do another prostate biopsy or other lab tests. Further testing is especially important if high-grade PIN cells are found in different parts of your prostate.

Atypical Small Acinar Proliferation 

Another type of abnormal finding is cells that look like they may be cancerous, but there are too few of them to make a cancer diagnosis. This is called atypical small acinar proliferation (ASAP), or atypical glandular proliferation. To rule out prostate cancer, your urologist may recommend a repeat biopsy in a few months. 

Proliferative Inflammatory Atrophy

The third type of abnormal finding is when prostate cells look smaller than normal and/ or there are signs of inflammation. Called proliferative inflammatory atrophy (PIA), it is not cancer. However, PIA can lead to high-grade PIN or progress to prostate cancer in the future. 

Positive Findings: When Prostate Cancer is Found

The pathology report will be positive if cancer cells are found in your biopsy samples. If cancer is found it’s best to seek treatment by a cancer specialist called an oncologist.

The next step is to “grade” the prostate cancer based on how abnormal the cells look under a microscope. Grading is important because it helps your oncologist make decisions about treatment options, how often you need to be tested, and help you take good care of your overall health. 

The more abnormal the cells look, the more likely cancer will grow and spread quickly. Grade 1 means the cells look like normal prostate tissue. Grade 5 means cells look very abnormal. Grades 2, 3, and 4 have different features and levels of severity. Most prostate cancers are grade 3 or higher. 

Oncologists use two methods to grade prostate cancer. The Gleason system is the traditional method, and Gleason scores range from 2 to 10. The Grade Groups system grades cancer from 1 to 5. You may see one or both methods used in your pathology report.  

Gleason Scores

Prostate cancer can have areas with different grades. If this is the case, your report will have two grades, known as primary and secondary patterns, that reflect the two areas that make up most of the cancer cells. For example, if most of your cancer is grade 3 and a smaller amount is grade 4, your Gleason score is listed as 3+4=7. The first number listed (3, in this example) means most of the cells are that grade. A Gleason score of 6 or lower is considered low-grade; a score of 7 means an intermediate grade; an 8 to 10 score is high-grade cancer. 

Grade Groups

Grade groups are being used more often in modern oncology practices because they provide more accuracy than just using a Gleason score.   

  • Grade group 1 is the same as a Gleason score of 6 or less.
  • Grade group 2 is the same as a Gleason score of 3+4=7.
  • Grade group 3 is a Gleason score of 4+3=7.
  • Grade group 4 is a Gleason score of 8.
  • Grade group 5 is a Gleason score of 9 to 10.

There may be other information in your pathology report, such as the number of samples taken, how many contain cancer, the percentage of cancer in each sample, and if the cancer is on the left or right side or on both sides (bilateral).

Types of Prostate Cancer

The pathology report can also indicate the type of prostate cancer you have. Different types of cancer start in different types of cells. It’s important to know the type to decide on the best treatment for you. Your oncologist will also consider the cancer grade (how abnormal the cells are) and the prostate cancer stage (size of cancer and whether it has spread). 

Types of prostate cancer:

    • Acinar adenocarcinoma, by far the most common type, develops in the cells lining the prostate. 

    • Ductal adenocarcinoma grows and spreads most quickly, starting in the cells lining the prostate ducts.

    • Transitional cell cancer starts in the lining of the urethra tubes. It usually starts in the bladder, spreading into the prostate.

    • Squamous cell cancer tends to grow and spread more quickly, starting in the cells covering the prostate. 

    • Small cell prostate cancer begins in neuroendocrine cells. 

A Personal Approach to Understanding Your Diagnosis 

Compass Oncology provides the comprehensive, patient-centered care and treatment you need during this time. Compass Oncology’s oncologists and nurses were recently named “Top Doctors + Nurses 2021” by Portland Monthly. Compass Oncology is part of the US Oncology Network. We know our patients’ names and faces, their stories, struggles, and their victories. We’re with you every step of the way in your fight against cancer. If you have received a prostate cancer diagnosis, request an appointment for a review of your test results and a discussion about what is the best next step for you.

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