Understanding prostate cancer can take time, and it’s normal to have questions.
Being told you have prostate cancer after a biopsy can feel overwhelming. Many men are unsure what the results actually mean and what happens next.
When your urologist reviews your biopsy results, they are looking at several important details to understand how significant the cancer is and what treatment (if any) may be needed.
Here’s a simple guide to what those results mean.
1. Was Cancer Found?
The first question is straightforward:
Cancer present
No cancer found
If cancer is found, the next step is to understand how aggressive it might be.
2. The Gleason Score – Understanding Cancer Aggressiveness
One of the most important parts of a prostate biopsy result is the Gleason Score.
This score describes how abnormal the prostate cancer cells look under a microscope and helps predict how the cancer may behave.
The score is made from two numbers added together, such as:
3 + 3 = 6
3 + 4 = 7
4 + 3 = 7
These numbers represent the most common patterns of cancer cells seen in the biopsy.
For example:
3 + 4 = 7
Most of the cancer is the less aggressive pattern (3), with a smaller amount of pattern 4.4 + 3 = 7
There is more aggressive cancer present, even though the total score is the same.
So while both equal 7, 4+3 cancers are generally considered more aggressive than 3+4 cancers.
3. ISUP Grade Groups
To make things simpler, doctors often use Grade Groups, which range from 1 to 5.
Grade Group | Gleason Score | What It Means |
|---|---|---|
Grade 1 | 3+3=6 | Least aggressive |
Grade 2 | 3+4=7 | Mostly low-grade cancer |
Grade 3 | 4+3=7 | More aggressive |
Grade 4 | Gleason 8 | High-grade cancer |
Grade 5 | Gleason 9–10 | Most aggressive |
This grading helps doctors determine how likely the cancer is to grow or spread.
4. How Much Cancer Was Found?
Your biopsy also tells us how much cancer is present.
Doctors look at:
How many biopsy cores contain cancer
What percentage of each core is cancer
This information helps estimate how extensive the cancer may be within the prostate.
5. Other Important Features
Sometimes additional findings appear in the biopsy report that give doctors more clues about the behaviour of the cancer.
These may include:
Perineural invasion – cancer near nerves
Lymphovascular invasion – cancer near blood vessels or lymph channels
Extraprostatic extension – cancer appearing beyond the prostate capsule
Seminal vesicle involvement
These findings help doctors understand whether the cancer might be more aggressive.
6. Imaging After Diagnosis
Once prostate cancer is diagnosed, doctors often recommend staging scans to see if the cancer has spread.
At the Prostate Clinic, this typically involves a PSMA PET scan.
This scan:
Looks at the whole body
Helps detect any spread of prostate cancer
Provides important information to guide treatment decisions
What Happens Next?
After reviewing:
Your biopsy results
Your MRI
Your PSMA PET scan
Your PSA levels
Your doctor can recommend the most appropriate next step, which may include:
Active surveillance
Surgery
Radiation therapy
Focal therapy
Other treatment options
Every prostate cancer diagnosis is different, and the best treatment depends on the specific characteristics of your cancer.
Have Questions?
Understanding prostate cancer can take time, and it’s normal to have questions.
At the Prostate Clinic, we regularly provide educational resources and opportunities for patients to learn more and ask questions.