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After you have your prostate biopsy, the tissue will be sent to the pathologists who are analyzed
that under a microscope. If you are found to have prostate cancer, the pathologist will
give a Gleason scoring of that cancer. This Gleason score is used to grade the cancer
cells based on a scale of 1 to 5. One being slower growing, less aggressive, better differentiated,
five being faster growing less differentiated, and more aggressive. Pathologist will look
at the two dominant areas of cancer on the site and give a summary of those two scores,
so typically your Gleason score will contain two numbers added together to give a sum.
Most prostate cancers will give you a score ranging from 5 to 10. Five is more well-differentiated,
slower growing, and less aggressive, 10, however, is much more aggressive cancer, poorly differentiated
and faster growing. The staging of prostate cancer is based upon several factors including
your Gleason score, your PSA score and your TNM score. TNM refers to the staging system
that is most commonly used. T refers to the size of the prostate cancer, N refers to the
presence or absence of lymph node involvement, and M refers to the presence or absence of
metastatic disease to other organs, T1 refers to prostate cancer that cannot be felt by
digital *** exam, T2 refers to cancers that are large enough to be palpated on ***
exam, T3 refers to prostate cancer that has escaped outside the prostate capsule or perhaps
invaded the seminal vesicles where *** is stored, T4 refers to prostate cancer that
invades other organs around the prostate such as the ***, the bladder, or the muscle
wall. We will often group prostate cancer into low, intermediate, or high risk. Low
risk prostate cancer is men who have a PSA less than 10 and have a T1 or T2 disease that
is a Gleason five or six. Intermediate risk is a man who has a PSA between 10 to 20, a
Gleason score of 7 or 8 or T2 or T1 disease. Poor risk or high risk prostate cancer is
men, whose PSA is over 20 or they have a Gleason 9 or 10 or they are T3 or T4 staging.