By now, you know that prostate cancer tends to grow slowly. Your cancer cells probably will take many years from the moment the earliest cell changes could be seen under a microscope until the cancer causes symptoms which you could feel.
This year, and likely for many years to come, Prostate cancer can be diagnosed only by examining tissue under the microscope. And that means taking a biopsy of your prostate.
To get a biopsy, go to a urologist. Biopsies are almost always performed in the urolologists' office. Using a transrectal ultrasound (TRUS) probe, the urologist first images your prostate, then inserts hollow biopsy needles into areas of the gland that feel or look suspicious. Bits of tissue are removed from each site through the needles; each snip causes a sharp sting. Discuss in advance for anesthesia or pain reduction medication. If a tissue sample is taken because of an elevated PSA test rather than a suspected abnormal area in the prostate gland, random tissue samples are often taken from six or more sectors of the prostate.
In a so-called pattern biopsy, tissue samples are obtained from half a dozen or more carefully spaced sectors of your prostate gland; this helps establish the size and extent of any cancer. However, even when multiple samples are taken, biopsy can miss some cancers. Discuss in advance how many samples will be taken and from what areas of the prostate they will be taken. Ask if samples will be taken from the apex of the prostate and if 12 or more samples will provide a better picture of what is going on inside of your prostate.
Your biopsy tissue samples are then examined by a pathologist; a doctor who studies and identifies the cell and tissue changes produced by disease.
Considering Your Chances of Survival
Your chances of being alive, and disease-free, 10 or 15 years after diagnosis usually depend more on the stage and grade of your cancer than on the choice of treatment. The best outlook is for patients with smaller, slow-growing, well-differentiated tumors. The good news is that approximately three-quarters of all newly diagnosed prostate cancers are clinically localized (Stage I or Stage II). About 15 percent are Stage III, and 11 percent are Stage IV.
Grading the Cancer
Healthy prostate cells are uniform in size and shape, neatly arranged in the patterns of a normal gland. As cancer grows, they lose their healthy look. They change from normal, well-differentiated tissues to more disorganized, poorly differentiated tissue. Eventually, a tumor develops.
If your biopsy shows the presence of prostate cancer, the pathologist assigns each tissue sample a grade, indicating how far the cells have traveled along the path from normal to abnormal. The grade offers a good clue to your tumor's behavior: a tumor with a low grade is likely to be slow-growing, while one with a high grade is more likely to grow aggressively or already to have spread outside the prostate (metastasized). The most widely used grading method for prostate cancer is known as the Gleason grading system.
Tumor grade is a good predictor of outcome. In one analysis, 10 years after prostatectomy for localized cancer, prostate cancer had claimed the lives of 6 percent of the men whose cancers were well differentiated compared with 20 percent of those with moderately differentiated cancers and 23 percent of those with poorly differentiated cancers.
The chances of developing metastatic prostate cancer followed a similar pattern. Ten years after surgery, metastasis had been diagnosed in 13 percent of the men with well-differentiated tumors, but in 32 percent of those with cancers that were moderately differentiated and 48 percent of those whose cancers were poorly differentiated.