After you learn that you have prostate cancer, you may need other tests to help with making decisions about treatment.
Tumor Grade Test with Prostate Tissue
The prostate tissue that was removed during your biopsy procedure can be used in lab tests. The pathologist studies prostate tissue samples under a microscope to determine the grade of the tumor. The grade tells how different the tumor tissue is from normal prostate tissue.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.
The most commonly used system for grading prostate cancer is the Gleason score. Gleason scores range from 2 to 10.
To come up with the Gleason score, the pathologist looks at the patterns of cells in the prostate tissue samples. The most common pattern of cells is given a grade of 1 (most like normal prostate tissue) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5 and then adds the grades for the two most common patterns together to make the Gleason score (3 + 4 = 7). If only one pattern is seen, the pathologist counts it twice (5 + 5 = 10).
A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.
For more about tumor grade, see the NCI fact sheet Tumor Grade.
Staging tests can show the stage (extent) of prostate cancer, such as whether cancer cells have spread to other parts of the body.
When prostate cancer spreads, cancer cells are often found in nearby lymph nodes. If cancer has reached these lymph nodes, it may have also spread to other lymph nodes, the bones, or other organs.
Your doctor needs to learn the stage of the prostate cancer to help you make the best decision about treatment.
Staging tests may include…
- Physical exam (digital rectal exam): If the tumor in the prostate is large enough to be felt, your doctor may be able to examine it. With a gloved and lubricated finger, your doctor feels the prostate and surrounding tissues from the rectum. Hard or lumpy areas may suggest the presence of one or more tumors. Your doctor may also be able to tell whether it’s likely that the tumor has grown outside the prostate.
- Bone scan: A small amount of a radioactive substance will be injected into a blood vessel. The radioactive substance travels through your bloodstream and collects in the bones. A machine called a scanner makes pictures of your bones. Because higher amounts of the radioactive substance collect in areas where there is cancer, the pictures can show cancer that has spread to the bones.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your lower abdomen or other parts of your body. You may receive contrast material by injection into a blood vessel in your arm or hand, or by enema. The contrast material makes it easier to see abnormal areas. The pictures from a CT scan can show cancer that has spread to the lymph nodes or other areas.
- MRI: A strong magnet linked to a computer is used to make detailed pictures of your lower abdomen. An MRI can show whether cancer has spread to lymph nodes or other areas. Sometimes contrast material is used to make abnormal areas show up more clearly on the picture.
Questions you may want to ask your doctor about tests
- May I have a copy of the report from the pathologist?
- What is the grade of the tumor?
- Has the cancer spread from the prostate? If so, to where?
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