If you’ve had a prostate biopsy, your doctor wants to determine if there are abnormal cells in various areas with the prostate gland. After the tissue samples are taken, they’re studied by a doctor called a pathologist. They will evaluate the cells and make notations about what they see under a microscope.
The findings of the analysis are recorded in a pathology report. It's sent to your doctor who will review it with you. It's important to understand your pathology report so you can have a clear idea of what's happening in your prostate.
How is My Prostate Pathology Report Related to my PSA Levels?
Your PSA levels are not measured during the biopsy. Rather, it’s a blood test used to see if your levels of prostate-specific antigen are rising. PSA is a protein made by the prostate. An elevated PSA is between 4.0 and 10.0 ng/mL for men over age 60, higher than 2.4 ng/ml for men under age 60.
However, your PSA level can be elevated due to several conditions, one of which is prostate cancer. An elevated PSA doesn’t necessarily mean you have prostate cancer. Normal aging, infection, certain medications, or an enlarged prostate can cause the numbers to be elevated. Your doctor will watch for steady increases of PSA levels during your regular visits before recommending a biopsy.
What Does a Negative Result Mean?
A negative result on your pathology report is actually a good thing. It means no prostate cancer was found in the tissue samples that were tested. If you receive a negative or benign result and have a PSA level that hasn’t changed much, your doctor may not do additional testing. If PSA starts to rise again, another biopsy or other testing may be needed.
If you have prostate cancer-related symptoms but still receive a negative result, additional testing may be recommended to rule out a false-negative result. This will require a second biopsy to test different areas of the prostate that weren't tested with the first biopsy.
What Do Abnormal Report Findings Mean?
If your pathology report indicates abnormal or atypical findings, it means there are changes in your prostate cells. It does not necessarily mean prostate cancer is present. Let's review some of the atypical findings and what they mean.
Prostatic intraepithelial neoplasia (PIN) is one type of atypical finding. PIN cells can be high- or low-grade.
Low-grade PIN cells are close to normal and do not increase prostate cancer risk. They are not included in a pathology report.
High-grade PIN cells look more abnormal and are considered precancerous. They indicate a significant risk of developing prostate cancer at some point. Your oncologist may recommend another biopsy and additional lab tests, especially critical if PIN cells are found in different areas of your prostate.
Atypical small acinar proliferation (ASAP) means abnormal cells appear cancerous, but there aren't enough of them to make an official prostate cancer diagnosis. You may need another biopsy in a few months.
Proliferative inflammatory atrophy (PIA) means your prostate cells look smaller than normal, or there are signs of inflammation. This is considered an abnormal finding, but it's not cancer.
Understanding a Positive Result on a Pathology Report
If your pathology report indicates your biopsy was positive, it means cancer cells were found. Your oncologist will use the information in the report, along with some other testing, to develop a treatment plan.
Depending on how abnormal the cells look, the best course of action may be active surveillance – sometimes referred to as watchful waiting. This means you don’t start treatment right away, but rather you’ll be monitored every few months to see if there are indications that the cancer has started to grow further.
What Does the Prostate Cancer Grade Mean?
Grading is one of the most important pieces of information on your pathology report. It helps determine if treatment should begin now or later. It's based on how abnormal the cells look and can determine if additional testing is needed in the future.
Oncologists use two methods to grade prostate cancer. The Gleason score is the traditional method, and the grade group score is increasingly used by oncologists.
Gleason scores are determined by assigning a grade to two abnormal areas biopsied in your prostate. The grades are added together to get your Gleason score. A score of 6 or lower is low-grade; 7 is intermediate, and 8 to 10 is high-grade cancer.
A grade group on your pathology report will be between 1 and 5. Grade group 1 is low-risk; grades 2 and 3 are intermediate, and a grade of 4 or 5 indicates high/very high risk.
The higher the grade or the Gleason Score, the sooner you’ll need to start treatment. For those with symptoms and a high grade cancer, you’ll also be evaluated with some imaging tests to see if the cancer has spread outside of the prostate.
Other information that may be included in your pathology report includes:
Number of samples taken
Number of samples that contain cancer
Percentage of cancer in each sample
Location of cancer (left, right, or both sides of the prostate)
Whether there is perineural invasion, which means cancer cells are surrounding or near a nerve fiber within the prostate, usually indicates that prostate cancer has spread outside the prostate
Type of prostate cancer you have may not be included in all pathology reports because it requires additional testing
Learn More About Your Prostate Cancer Pathology Report
The oncologists at Radiotherapy Clinics of Georgia want every patient to have a clear understanding of their testing, diagnosis, and cancer treatment plan. Our team is here to help you determine what next steps are best for you. Request an appointment with one of our oncologists at a location in the greater Atlanta area that's convenient for you–we also offer second opinions.