If you’ve had a prostate biopsy your doctor suspected that cancer may be present and used this test to gather data. After the biopsy is performed, taking several tissue samples from throughout the prostate, a report is created that describes what was found. This is called a pathology report. One of the first things evaluated is whether there are abnormal cells present, and if so, how abnormal did they look. This information is then used by the oncologist to better understand:

• Grade of the prostate cancer
• Stage of the prostate cancer
• Recommended next steps

As you can see, there is a lot of useful information in these reports. However, it's not uncommon for people to have difficulty understanding it because the reports include several unfamiliar terms. If you've received your pathology report and feel like you have more questions than answers, it can be helpful to break it down into easier-to-understand pieces. Let's go over some of the common things you'll see on a prostate pathology report and what they mean. Of course, you can always reach out to your physician for help with understanding what the reports says.

Understand Your PSA Levels Before a Biopsy 

One reason doctors recommend prostate biopsies is because of an elevated level of PSA (prostate specific antigen) in the blood. PSA is considered elevated when it’s between 4.0 and 10.0 ng/mL. While this can be caused by several other medical conditions, an elevated PSA over a period of time with no other known cause is an indicator that a biopsy may provide insight. 

Other conditions that can raise your PSA level include:

• Natural aging 
• Infection or inflammation 
• Certain medications 
• Enlarged (non-cancerous) prostate 

Your PSA levels are not measured in the biopsy.

You may be asked to have a repeat biopsy if your PSA levels rise between checkups. 

What Does a Negative Result Mean on a Prostate Biopsy Report? 

A negative result in a biopsy pathology report is a good thing! It means there was no prostate cancer found in the tested tissue. Your report may also indicate that your results are "benign," which also means that there are no signs of prostate cancer in the biopsied samples. 

If you receive a negative or benign result coupled with a low PSA (prostate-specific antigen test result), then your doctor may indicate that there is no need for additional testing. Keep in mind; your doctor may still schedule future PSA blood tests and potentially another biopsy in the future based on the PSA test results. 

In some cases, if you've been experiencing prostate cancer-related symptoms and still receive a negative result, additional testing may be recommended to rule out a false negative. To do this, you'll undergo a second biopsy that tests other areas of the prostate that were not tested during the first biopsy. In some instances, doctors may ask for blood or urine samples to get a better picture of your health. 

Understanding Atypical or Abnormal Findings on Your Prostate Biopsy Pathology Report 

The pathology report may include results that are medically known as atypical or abnormal. This result means that there are changes in your prostate cells but doesn't necessarily mean prostate cancer is present. 

Prostatic Intraepithelial Neoplasia

Prostate intraepithelial neoplasia (PIN) is one type of atypical finding that may be found on a prostate pathology report. PIN cells can be high- or low-grade. 

• Low-grade PIN cells are closer to normal. They can occur in younger men, and nearly half of all men have PIN by the time they reach 50 years of age. It's important to note that low-grade PIN cells do not increase prostate cancer risk. Since they are of such low significance when it comes to cancer identification, they are not included as part of the pathology report. 

• High-grade PIN cells look more abnormal and are considered pre-cancerous cells. To put it simply, these types of cells increase your risk of developing cancer at some point during your life. Since this is considered a significant risk, your doctor will likely want to do another biopsy as well as additional lab tests. It is especially critical to complete additional testing if PIN cells are found in different areas of your prostate.   

Atypical Small Acinar Proliferation 

Atypical small acinar proliferation (ASAP) is when abnormal cells are present and appear cancerous, but there aren't enough of them to make an official prostate cancer diagnosis. To rule out prostate cancer, your doctor will most likely suggest another biopsy in a few months. 

Proliferative Inflammatory Atrophy

Prolific inflammatory atrophy (PIA) is when the prostate cells look smaller than normal, or there are signs of inflammation. This is considered an abnormal finding but is not cancer.

Understanding a Positive Result on a Prostate Biopsy Report

If your pathology report indicates that the sampled biopsy is positive, this means cancer cells were found. The next step in the process is to get a better understanding of your situation. This frequently involves working with a prostate cancer specialist. Further information is frequently necessary to identify the best treatment plan for your particular type of prostate cancer. You'll work with a cancer specialist known as an oncologist to determine the best option for you. 

In some cases, the best course of action may be active surveillance. This means that you'll be required to visit your doctor more often and undergo testing to keep a close eye on the cancer and its progression. 

Prostate Cancer Grade and How This Impacts Treatments

Oncologists use two methods to grade prostate cancer. The Gleason Score is the traditionally used method with scores ranging from 2 to 10. Based on the score, a Grade Group may also be determined between 1 and 5.

Grading is one of the most critical pieces of information that you'll get from your pathology report. The grade is one of the determining factors in whether treatment should begin now or can be delayed, based on how abnormal the cells look when viewed under a microscope. Understanding the grade of your cancer will help create a treatment plan and determine additional screenings and tests you may need to do in the future. 

Gleason Scores

The pathologist will determine how abnormal the cells are from more than one location in the prostata. Based on that, two more abnormal areas are given a number which are then added together. Here is an example to help you understand the Gleason Score: 

If most of your cancer is grade 3 and a smaller amount is grade 4, your Gleason score is listed as 3+4=7. The first number listed (3, in this example) means most of the cells are that grade. A Gleason score of 6 or lower is considered low-grade; a score of 7 means an intermediate grade; an 8 to 10 score is high-grade cancer. 

Grade Groups

You may also see a Grade Group listed on the report. This helps the oncologist decide if and when treatment is appropriate. Here is a breakdown of the grade groups. 

LOW RISK

• Grade Group 1 is the same as a Gleason score of 6 or less. 

INTERMEDIATE RISK

• Grade group 2 is the same as a Gleason score of 3+4=7.
• Grade group 3 is a Gleason score of 4+3=7.

HIGH/ VERY HIGH RISK

• Grade group 4 is a Gleason score of 8.
• Grade group 5 is a Gleason score of 9 to 10.

Additional Information in Your Pathology Report

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 that cancer cells are seen surrounding or near a nerve fiber within the prostate if this is found, it means that it's likely prostate cancer has spread outside the prostate.

It is important to carefully examine all of the findings of your pathology report. This information can help paint a better picture of what is happening in your prostate. 

Types of Prostate Cancer

This information is not always available in all pathology reports. Sometimes identifying the specific type of prostate cancer is based on additional testing. If those tests have been completed, this information may be included in your pathology report, but this is not a standard reporting measure for every pathology report. 

• Acinar adenocarcinoma develops in the glandular cells of the prostate. This is the most common form of prostate cancer that is diagnosed. 
• Ductal adenocarcinoma starts in the ductal cells of the prostate and tends to grow and spread rapidly. 
• Transitional cell cancer begins in the lining of the urethra tubes in the bladder and then spreads to the prostate. 
• Squamous cell cancer very rare but aggressive type 
• Small cell prostate cancer starts in neuroendocrine cells of the prostate  

Understanding Your Pathology Report  

Minnesota Oncology wants every patient to have a clear understanding of their testing, diagnosis, and treatment plan. If you've recently completed a prostate biopsy and were given a prostate cancer diagnosis, our team is here to help you determine the best next steps. Treatment doesn't always start right away. But the information in this report will be one of the keys in determining what’s best for you. 

Request an appointment with one of our oncologists at a location in the Twin Cities that’s convenient for you. Second opinions are also available.