Your doctor will look at all your test results to get an idea of how quickly your cancer might grow and whether it has spread. This will help you to discuss which treatments might be suitable for you.
It’s normal to have a small amount of PSA in your blood, and the amount rises as you get older. Other things can also affect your PSA level. You may have had a PSA test that showed your PSA was raised, and then had other tests to diagnose your prostate cancer.
After you’ve been diagnosed, you will have regular PSA tests. If you have treatment, this is a useful way to check how well your treatment has worked. If your PSA level falls this usually suggests your treatment is working.
If you decide not to have treatment straight away, you will have regular PSA tests to check if your cancer might be growing.
Gleason grade and Gleason score
Your doctor may talk about your Gleason grade and Gleason score after your biopsy.
Prostate cancer cells in your biopsy samples are given a Gleason grade. This tells you how aggressive the cancer is – in other words, how likely it is to grow and spread outside the prostate.
When cancer cells are seen under the microscope, they have different patterns, depending on how quickly they’re 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 grades 1 and 2 are not cancer.
There may be more than one grade of cancer in the biopsy sample. 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 these two grades are added together, the total is called the Gleason score.
Gleason score = the most common grade + the highest other grade in the samples.
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).
A Gleason score of 4+3 shows that the cancer is slightly more aggressive than a score of 3+4, as there is more grade 4 cancer.
If you have prostate cancer, your combined Gleason score will be between 6 (3+3) and 10 (5+5). You might only be told your total Gleason score, and not your 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.
- A Gleason score of 6 suggests the cancer is slow-growing.
- A Gleason score of 7 suggests the cancer may grow at a moderate rate.
A Gleason score of 8, 9 or 10 suggests the cancer may grow more quickly
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 shows how far the cancer has spread in and around the prostate.
- The N stage shows whether the cancer has spread to the lymph nodes.
- The M stage shows whether the cancer has spread to other parts of the body.
The T stage shows how far the cancer has spread in and around the prostate. A DRE is usually used to find out the T stage. You might also have an MRI scan or a CT scan to confirm your T stage.
If your T stage is T1 or T2, you will be diagnosed with localised prostate cancer. T3 and T4 are both locally advanced prostate cancer. If cancer has spread to other parts of the body, it is advanced prostate cancer.
T1 prostate cancer
The cancer can’t be felt or seen on scans, and can only be seen under a microscope.
T2 prostate cancer
The cancer can be felt or seen on scans, but is still contained inside the prostate.
- T2a - the cancer is in half of one side (lobe) of the prostate, or less.
- T2b - the cancer is in more than half of one of the lobes, but not in both lobes of the prostate.
- T2c - the cancer is in both lobes but is still inside the prostate.
T3 and T4 prostate cancer
If your T stage is T3, this means your cancer is starting to break through the capsule of the prostate. If your T stage is T4, the cancer has spread to nearby organs, such as the neck of the bladder, back passage, pelvic wall or lymph nodes. T3 and T4 are both locally advanced prostate cancer.
The N stage shows whether your cancer has spread to the lymph nodes near the prostate. This is a common place for prostate cancer to spread to. An MRI or CT scan is used to find out your N stage.
If you have localised prostate cancer, your cancer is contained inside the prostate and will not have spread to the lymph nodes.
The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones. A bone scan is usually used to find out the M stage. But most men with localised prostate cancer won’t need a bone scan because the cancer is contained inside the prostate and will not have spread around the body.
Read more about staging.
Ask your doctor or nurse to explain your test results if you don’t understand them. Or call our Specialist Nurses