Getting the results

It usually takes around two weeks to get all the results. These can give an indication of how far the cancer has spread and how quickly it might be growing.

  • If your PSA test shows that you have a high PSA level for your age, this could be a sign of prostate cancer, but it can also be caused by other things.
  • If your DRE shows that your prostate is larger than expected this could be a sign of an enlarged prostate. A prostate with hard, bumpy areas may suggest prostate cancer.
  • If your biopsy shows there is cancer present, the results are used to work out your Gleason score. This can give an idea of how likely the cancer is to spread.
  • The results of any scans you might have had will help to stage your cancer to show how far the cancer might have spread.

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Gleason grade

If there are prostate cancer cells in your biopsy samples, they are given a Gleason grade. This tells you how aggressive the cancer is – which means how likely it is to grow and spread outside the prostate.

When cancer cells are looked at under the microscope, they have different patterns, depending on how quickly they are likely to grow. The pattern is given a grade from 1 to 5. This is called the Gleason grade. If a grade is given, it will usually be 3 or higher, as grade 1 and 2 are not cancer.

Gleason score

There may be more than one grade of cancer in the biopsy samples. An overall Gleason score is worked out by adding together two Gleason grades.

The first is the most common grade in all the samples. The second is the highest grade of what’s left. When the most common and the highest grade are added together, the total is called the Gleason score. 

For example, if the biopsy samples show that:

  • most of the cancer seen is grade 3 and
  • the highest grade of any other cancer seen is grade 4, then
  • the Gleason score will be 7 (3+4).

Because grade 1 and 2 are not cancer, the combined Gleason score is normally 6 or higher. So your Gleason score can normally only be between 6 (3+3) and 10 (5+5).

Some men will only be told their total Gleason score and not given their Gleason grades. 

What does the Gleason score mean?

The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread.

  • 3+3 - All of the cancer cells found in the biopsy look likely to grow slowly.
  • 3+4 - Most of the cancer cells found in the biopsy look likely to grow slowly. There were some cancer cells that look more likely to grow at a more moderate rate.
  • 4+3 - Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There were some cancer cells that look likely to grow slowly.
  • 4+4 - All of the cancer cells found in the biopsy look likely to grow at a moderately quick rate.
  • 4+5 - Most of the cancer cells found in the biopsy look likely to grow at a moderately quick rate. There were some cancer cells that are likely to grow more quickly.
  • 5+4 - Most of the cancer cells found in the biopsy look likely to grow quickly.
  • 5+5 - All of the cancer cells found in the biopsy look likely to grow quickly.

 Your doctor or nurse will talk you through what your results mean.

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Staging

Staging is a way of recording how far the cancer has spread. The most common method is the TNM (Tumour Nodes Metastases) system.

  • The T stage measures the tumour.
  • The N stage measures whether the cancer has spread to the lymph nodes.
  • The M stage measures whether the cancer has spread (metastasised) to other parts of the body.

T Stage

The T stage shows how far the cancer has spread in and around the prostate. This is measured by a DRE. You may also have an MRI scan to confirm your T stage.

T1 prostate cancer
The cancer can’t be felt or seen on scans, and can only be seen under a microscope – localised prostate cancer.

T1 prostate cancer

 

T2 prostate cancer
The cancer can be felt or seen on scans, but it is contained within the prostate – localised prostate cancer.

T2 Prostate Cancer

 

T3 prostate cancer
The cancer can be felt or seen breaking through the capsule of the prostate – locally advanced prostate cancer.

  • T3a The cancer has broken through the capsule of the prostate but has not spread to the seminal vesicles (which produce some of the fluid in semen).
  • T3b The cancer has spread to the seminal vesicles.

T3 Prostate Cancer

 

T4 prostate cancer
The tumour has spread to nearby organs, such as the neck of the bladder, back passage, pelvic wall or lymph nodes – locally advanced prostate cancer.

T4 Prostate CancerN Stage

The N stage shows whether the cancer has spread to the nearby lymph nodes. The lymph nodes in the groin are a common place for prostate cancer to spread to. They are looked at with an MRI or CT scan.

You may be offered one of these scans if you’re thinking about having a treatment such as radiotherapy or surgery and there is a risk that your cancer might have spread to your lymph nodes.

  • NX The lymph nodes were not measured.
  • N0 No cancer cells can be seen in the lymph nodes.
  • N1 The lymph nodes contain cancer cells.

If your scans suggest that your cancer has spread to the lymph nodes (N1), it may either be treated as locally advanced or advanced prostate cancer. This may depend on several things, such as how far it has spread (M stage).

M Stage

The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones. This is measured using a bone scan.

Your doctor may offer you a bone scan if they think your cancer may have spread.

  • MX The spread of the cancer was not measured.
  • M0 The cancer has not spread to other parts of the body.
  • M1 The cancer has spread to other parts of the body.

If you have a bone scan and the results show that your cancer has spread to other parts of the body (M1), you will be diagnosed with advanced prostate cancer.

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Localised prostate cancer

Localised prostate cancer is cancer that is contained within the prostate gland. It is also called early or organ-confined prostate cancer.

Prostate cancer can behave in different ways. Many localised cancers are not aggressive and will not cause any problems in your lifetime. However, some cancers may grow more quickly and spread to other parts of the body.

The tests you have had can give your doctor and idea of how the cancer will behave and what treatments may be suitable for you.

What is the chance my cancer will spread?

Doctors often divide localised prostate cancers into risk groups. This is the risk of the cancer coming back after treatment. This is used to help decide which treatment options are suitable for you.

Low risk

  • your PSA level is 10ng/ml or less, and
  • your Gleason score is 6 or less, and
  • the stage of your cancer is T1 to T2a

Medium risk

  • your PSA level is between 10 and 20ng/ml, or
  • your Gleason score is 7, or
  • the stage of your cancer is T2b or T2c

High risk

  • your PSA level is 20 ng/ml or higher, or
  • your Gleason score is 8 or higher, or
  • the stage of your cancer is T3 or T4.

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Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that is breaking through the capsule of the prostate, or has spread to the area just outside the prostate. This can include the seminal vesicles, lymph nodes, neck of the bladder or back passage.

Different doctors sometimes use the term "locally advanced prostate cancer" in slightly different ways, so ask your doctor or nurse what it means in your case.

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Advanced prostate cancer

Advanced prostate cancer is cancer that has spread from the prostate gland to other parts of the body. It is also called 'metastatic' prostate cancer. It develops when tiny prostate cancer cells move from the prostate to other parts of the body through the blood stream or lymphatic system.

Prostate cancer can spread to any part of the body but it most commonly spreads to the bones and the lymph nodes.

Advanced prostate cancer can cause symptoms, which may be the first sign that something is wrong for some men. Symptoms will depend on where the cancer has spread to, but can include bone pain or problems passing urine. Not all men diagnosed with advanced prostate cancer will have symptoms.

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What happens next?

The results will give your multi-disciplinary team (MDT) an idea of how your cancer is behaving and the most suitable treatment options for you.

If you are not sure whether your prostate cancer is localised, locally advanced or advanced, speak to your doctor or nurse. They can explain your test results and talk to you about your treatment options. Or you can call our Specialist Nurses. or speak to a nurse online if you are worried. You can also request a second opinion from another specialist by talking to your GP.

It can be hard to take everything in, especially when you've just been diagnosed with prostate cancer. You might find it useful to have someone with you at the consultation, or to make notes so that you can read them in your own time. There is also support available.

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Rare types of prostate cancer

As well as giving the Gleason score, a biopsy also looks at the type of cancer cells. For most men who are diagnosed, the type of prostate cancer is adenocarcinoma, or acinar adenocarcinoma. You might see this written on your pathology report. There are other types of prostate cancer, which are very rare. These include:

  • small cell prostate cancer (neuroendocrine prostate cancer)
  • large cell prostate cancer (neuroendocrine prostate cancer)
  • ductal prostate cancer (ductal adenocarcinoma)
  • mucinous prostate cancer (mucinous adenocarcinoma)
  • signet ring cell prostate cancer
  • basal cell prostate cancer (adenoid cystic prostate cancer)
  • prostate sarcomas, such as leiomyosarcoma.

If you are diagnosed with one of these rare kinds of prostate cancer, you can read more here. Speak to your doctor or nurse about what it means and about the treatments available to you.

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Questions to ask your doctor or nurse

  • What is my PSA level?
  • Will I need a biopsy? What type of biopsy will I have?
  • What are the risks and side effects of having a biopsy?
  • What are my Gleason grades and Gleason score?
  • Will I need an MRI, CT or bone scan?
  • What is the stage of my cancer? What does this mean?
  • What treatments are suitable for me?

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References

You can find a full list of references used to produce this page in our online fact sheet.