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Understanding your Diagnosis

Typically prostate cancer is diagnosed after closely examining biopsy cells through a microscope. There are several types of cells in the prostate, and each contributes in its own way to the prostate's development, architecture, and function. But cancer cells look different than normal prostate cells. Pathologists look for these differences first to detect the presence of cancer and then to determine the cancer grade.

Gleason Grading
The Gleason grading system accounts for the five distinct patterns that prostate tumor cells tend to go through as they change from normal cells to tumor cells. The cells are scored on a scale from 1 to 5:

  • "Low-grade" tumor cells (those closest to 1) tend to look very similar to normal cells.
  • "High-grade" tumor cells (closest to 5) have mutated so much that they often barely resemble the normal cells.

The Gleason Score

The pathologist looking at the biopsy sample assigns one Gleason grade to the most similar pattern in your biopsy and a second Gleason grade to the second most similar pattern. The two grades added together determine your Gleason score (between 2 and 10). Cancers with lower Gleason scores (2 - 4) tend to be less aggressive, while cancers with higher Gleason scores (7 – 10) tend to be more aggressive. It's also important to know if any Gleason 5 is present, and most pathologists will report this. Having any Gleason 5 in your biopsy or prostate puts you at a higher risk of recurrence.

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Questions to Ask

  • What is my risk of recurrence after surgery?
  • What is my risk of progression over time without therapy? Do I need immediate therapy?
  • Should I explore other treatment options and speaking with other specialists (urologists, radiation oncologists, medical oncologists) before deciding upon a final plan of action?
  • What are the common side effects of the treatments recommended and when do they occur?
  • How many men with prostate cancer do you treat (with surgery, radiation, etc) per year?
  • What should I do to keep my body and mind healthy now that I've been diagnosed with prostate cancer?
  • What is the chance that my cancer spread beyond the prostate?
  • Are there additional tests that we can do to gain the most complete understanding of the stage and aggressiveness of my cancer?
  • What are all of the treatment options?
  • What are the benefits of the type of therapy you are recommending?
  • What are the drawbacks/side effects of this type of therapy?
  • Will I have problems with incontinence or impotence?
  • Will I have other urinary or rectal problems?
  • What other treatment(s) might be appropriate and why?
  • Is my cancer likely to come back?
  • What can I do to improve the success of my therapy?
  • What kind of follow-up can I expect after treatment?


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