The Gleason Score is an important measure used to evaluate prostate cancer. It consists of two numbers: the first shows the most common cancer pattern, and the second shows the next most common pattern. This tells us about your disease profile and can give us valuable insight into potential treatment pathways moving forward.
What Is a Prostate Biopsy?
A prostate biopsy is a medical procedure used to obtain small samples of prostate tissue. It helps determine if prostate cancer is present. While techniques vary worldwide, in Australia, we perform a Transperineal biopsy—guided by ultrasound and typically done under general anaesthetic. This approach allows us to access the prostate through the skin (not the rectum), reducing infection risk and improving accuracy.
Why Is a Biopsy Recommended?
We may recommend a biopsy if:
Your PSA blood test is elevated
A digital rectal exam (DRE) shows abnormalities
An MRI scan reveals a suspicious area
Quick Fact:
An MRI is usually done before a biopsy. The MRI allows us to pinpoint suspicious areas in the prostate, ensuring any biopsy targets the right locations.
What Do We Look for in the Biopsy Results?
Once tissue samples are analysed by a pathologist, we ask the key question:
Is there prostate cancer present?
If no cancer is found, we may continue monitoring PSA levels or repeat testing as needed.
If cancer is found, we receive detailed information to guide treatment decisions.
Understanding the Gleason Score
One of the most important pieces of information from your biopsy is the Gleason score—a number that reflects how aggressive the cancer appears under the microscope.
Scores range from 6 to 10
Lower scores (like Gleason 3+3=6) suggest less aggressive cancer.
Higher scores (like Gleason 4+3=7) indicate more aggressive cancer.
The first number tells us the most common pattern of cancer seen, and the second number shows the next most common pattern. For instance:
Gleason 3+4=7: Mostly less aggressive cancer with a smaller portion that's more aggressive.
Gleason 4+3=7: A larger portion of more aggressive cancer, even though the total score is the same.
Assessing Cancer Volume (Disease Burden)
In addition to the Gleason score, we assess:
How many biopsy samples (cores) contain cancer
The percentage of each sample involved with cancer
Quick Fact:
If more cores are involved—or the cancer takes up a large percentage of a sample—it may suggest a higher burden, which plays a crucial role in treatment planning.
What Happens After a Positive Biopsy?
The next step is staging the cancer to determine whether it’s:
Localized to the prostate
Or has spread to other parts of the body
Traditionally, this involved CT and bone scans. Today, we primarily use PSMA PET scans, a cutting-edge technology that helps identify cancer cells throughout the body with high accuracy.
Common Side Effects After Biopsy
After a prostate biopsy, it’s common to experience:
⚠️Blood in the urine – usually clears within a few days
⚠️Blood in the stool – resolves quickly
⚠️Blood in the ejaculate – can be more noticeable and may persist for a few weeks. While alarming to some, it’s harmless and temporary.
What Guides Our Treatment Decisions?
We consider a range of factors to tailor the best care plan, including:
Gleason score and disease burden
Age and general health
Life expectancy and quality of life goals
FREQUENTLY ASKED QUESTIONS
Q: Is a prostate biopsy painful?
A: In Australia, it's usually done under general anaesthetic, so you won’t feel anything during the procedure.
Q: Will I need treatment if cancer is found?
A: Not always. Low-risk cancers (like Gleason 6) may only need monitoring (called active surveillance).
Q: How accurate is the biopsy?
A: Biopsy accuracy has improved greatly, especially when guided by MRI and performed via the Transperineal route.
Q: How long will it take to get results?
A: Typically, results are available within 2-5 days.
We’ll schedule a follow-up to discuss them in detail.
Q: What if I have a high Gleason score?
A: We’ll discuss treatment options tailored to your case—this may include surgery, radiotherapy, or other strategies, depending on your age, health, and cancer stage. In some cases, especially with low-risk cancers (e.g. Gleason 3+3=6), active surveillance—monitoring rather than immediate treatment—may be appropriate.
We appreciate your commitment to staying informed about your prostate health. Our clinic is dedicated to providing you with expert care, clear guidance, and genuine compassion throughout your journey. Should you have any questions or concerns, feel confident in reaching out to us.