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you'll be given an enema to clear out your bowels before Grade 1 is the lowest grade cancer and grade 5 is the
the procedure. There is also a higher risk of bleeding highest risk
after a transrectal biopsy compared to a transperineal Grade Group 1 = Gleason 6 (or less)
biopsy. Grade Group 2 = Gleason 3+4=7
Grade Group 3 = Gleason 4+3=7
In addition to where the needles are inserted there are Grade Group 4 = Gleason 8
different ways that urologists perform a prostate biospy. Grade Group 5 = Gleason 9-10
The traditional method is called a random biopsy, and
involves inserting 12 to 14 needles (referred to as Even if your Gleason score is in Grade Group 5 which is
cores), systematically into different parts of the prostate. the highest risk group, your other results such as your
With this method about one third of clinically significant PSA score and clinical staging are also important factors
prostate cancers will be missed. In men who have large for determining the possible outcome.
prostates the percentage of prostate tissue that is
sampled is naturally lower and the results are therefore Ask your doctor for a copy of your biopsy report as it
less reliable. contains a lot of other important information about your
diagnosis in addition to the Gleason score. You'll need it
If you have had an MRI before the biopsy then some if you want a second opinion, or if you want to do some
urologists will review the MRI images before and during research of your own before deciding on what treatment
the biopsy, and use the information to guide where best option is best for you.
to take samples from within the prostate. The success of
this technique is very much dependent on the urologist's Dealing with the diagnoses
ability to translate MRI images to transrectal ultrasound Being diagnosed with prostate cancer inevitably comes
without a physical overlay of the two images. So the with a sense of shock and even fear. It can be an
success of this method is very much operator overwhelming and confusing time with the overriding
dependant. This is called a cognitive fusion biopsy and it question often being “What now?”. First off, take a deep
has a higher detection rate than a random biopsy. breath or two to assist with keeping the panic at bay.
New technology is now available to combine or “fuse” Remember that most prostate cancers are slow growing,
MRI images with the live imaging from the transrectal meaning that you likely don't have to make all of your
ultrasound. This MRI/TRUS fusion technology involves decisions immediately. Prostate cancer that is
the use of sophisticated sand expensive software to diagnosed in the early stages can be cured and over
combine the two images. Remember that the MRI 98% of men who are diagnosed with early stage
provides a clear image of where the “area of interest” in prostate cancer will still be alive after 5 years.
the prostate is, so with this technology the urologist can ad
guide the biopsy needles directly to the potential tumour. Making an informed decision about what treatment is
This means that fewer needles will need to be used and best for you is important, as you are the one who has to
its success is not operator dependant. It's probably the live with the results. You need to make sure that you
method of the future.
fully understand the advantages and disadvantages of
all the treatment options that are available to you.
Understanding your biopsy results. Use credible sources to educate yourself about the
The samples obtained from the biopsy are sent to a different treatments. Our website has detailed
pathology laboratory. Each needle (core) obtained from information about the different treatment options.
a biopsy is analysed separately and the pattern of the
tissue in each core is given a separate diagnosis using Becoming part of a group of men who are going through
what's called a Gleason grading system. The pathologist a similar experience to you can be tremendously helpful.
assigns a grade between 1 and 5 to each sample. A It provides you with an opportunity to ask questions and
grade 1 pattern when viewed under a microscope looks express concerns to people who understand exactly
most like normal tissue and a grade 5 pattern is the what you are going through. Contact us and we'll
worst, as the tissue appearance is very abnormal. connect you to one of our e-mail support groups.
Although grades 1 and 2 appear different, they are now
reported as a grade 3 as they have the same outcomes.
A pure grade 3 cancer is unlikely to ever metastasize.
The Gleason score is most often obtained by adding the
number of the most common Gleason pattern with the
second most common. The lower the score, the less
aggressive the cancer and the less likely it is to
progress. It's important when interpreting a Gleason
score to understand that the order of the numbers is
highly significant, as the first number is always the most
prevalent type of pattern found. So even if the total is 7,
a Gleason score of 4 + 3 = 7 is worse than a Gleason
score of 3 + 4 = 7. That's because 4 indicates a more
aggressive cancer so if it is the most prominent in all of
the cores, that's worse than if 3 was the most prominent.
A new system has now been developed which makes it
a lot easier to understand the Gleason score and how
high risk the prostate cancer is. The Gleason scores are
reported in Grade Groups.
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