Biopsy & Gleason Score - Control Your Diagnosis

Your Gleason score is, "a fundamental determinant of disease biology and prognosis." That is from a very good article at prostate-cancer.org. In English, it means that the Gleason is one of the main tools they have for figuring out how serious and how aggressive your particular cancer is. It can have a large impact on the types of treatment that you are a candidate for.

The quality of your Gleason score is dependent on two things. The quality of the biopsy done by your urologist and the quality of the preparation and reading of the pathology slides by the pathologist.

First, the urologist. I think it goes without saying that the doctor should be board-certified in urology. I would want to go to someone who has done at least hundreds of biopsies and preferably thousands.

The first biopsy I had done five years ago was VERY painful. That does not have to be the case and I suggest that you confirm in advance that your doctor will use a local anesthetic in your prostate. The biopsy I had done this time was much less uncomfortable.

How many sites should the urologist take biopsy "cores" from in your prostate. (They are called "cores" because the doctor takes them using a hollow needle.) In the not too distant past, it was fairly common for a prostate biopsy to consist of four or six cores. Particularly in a guy with an enlarged prostate, that's why so many cases of cancer were either missed or under-diagnosed. I'm not able to find anything which definitively says that there should be "X" number of cores taken, but I think it is safe to say that the standard of care has become at least twelve cores. Each core should be placed in an individual container and mapped to show it's location in the prostate. I've even heard lately of patients who have had 24-core biopsies. Safe to say that the standard is evolving. You would be wise to ask your doctor how many he or she will use.

Never forget! It's your body, your decision. Be sure you understand what your doctor is suggesting and that you agree. Ask questions!

Second, the pathologist. Your Gleason Score is one way of grading the aggressiveness of your particular tumor(s). The Gleason Score is determined by a pathologist viewing your biopsy specimens. Because this is a critical issue for you, you want to have your biopsy examined specifically by a prostate cancer pathology expert who has done thousands of them. Just as it is a good idea to get a second opinion from another doctor on your diagnosis, it is a good idea to have your pathology slides examined by a second pathology expert. It is very common and expected. I actually had my slides examined by three different pathologists, all experts in prostate cancer.

In the next post, I'll try to explain what the Gleason score is and how it is arrived at.