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 the size of the cancer in 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.
You might not be told your N stage or your M stage – your doctor may just tell you whether your cancer has spread to the lymph nodes or to other parts of your body.
The T stage shows how far the cancer has spread in and around the prostate. A digital rectal examination (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 T3 or T4, you’ll be diagnosed with locally advanced prostate cancer.
T1 and T2 prostate cancer
- T1 - the cancer is completely contained inside the prostate and can only be seen under a microscope.
- T2 - the cancer is completely contained inside the prostate, but can be felt or seen on scans.
T1 and T2 are both localised prostate cancer.
T3 prostate cancer
The cancer can be felt or seen breaking through the capsule of the prostate.
- T3a - the cancer has broken through the capsule of the prostate, but has not spread to the seminal vesicles.
- T3b - the cancer has spread to the seminal vesicles.
T4 prostate cancer
The cancer has spread to nearby organs, such as the neck of the bladder, back passage, pelvic wall or lymph nodes.
The N stage shows whether the cancer has spread to the lymph nodes near the prostate. This is a common place for prostate cancer to spread to. An MRI scan or a CT scan is used to find out the N stage.
The possible N stages are:
- NX - the lymph nodes were not looked at, or the scans were unclear.
- N0 - no cancer can be seen in the lymph nodes.
- N1 - the lymph nodes contain cancer.
If your scans suggest that your cancer has spread to the lymph nodes (N1), it may be treated as either locally advanced or advanced prostate cancer. This will depend on several things, such as which lymph nodes are affected and whether the cancer has spread to other parts of the body.
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.
The possible M stages are:
- MX - the spread of the cancer wasn’t looked at, or the scans were unclear.
- M0 - the cancer hasn’t spread to other parts of the body.
- M1 - the cancer has spread to other parts of the body.
You may not need to have a bone scan if the results are unlikely to affect your treatment options. If you do have a bone scan and your cancer has spread (M1), you will be diagnosed with advanced prostate cancer.
For example, if your cancer is described as T3b, N0, M0, it is likely that your cancer:
- has spread to the seminal vesicles
- has not spread to your lymph nodes
- has not spread to other parts of your body.
If your cancer is described as T4, N1, M0 it is likely that your cancer:
- has spread to nearby organs
- has spread to nearby lymph nodes
- has not spread to other parts of your body.
Both of these examples are locally advanced prostate cancer.
Ask your doctor or nurse to explain your test results if you don’t understand them. You can also call our Specialist Nurses.