Prostate Cancer Risk

Prostate Cancer Information

How do I work out how serious my cancer is?

There are several considerations:

  • the underlying risk of the cancer affecting your quality of life
  • your general health

The underlying risk of the cancer is determined principally by:

  • Gleason Score: this is a measure of how aggressive the cancer is. The two commonest patterns of cancer are each graded from 1 to 5. The two grades are summed and the total is known as the Gleason score. Therefore, this ranges from 2 to 10. Most cancers have a Gleason Score of 6: the most serious is 10 and the best is 2.
  • Cancer Stage: This refers to how far the cancer has spread and can be determined partially by prostate examination with a finger, and sometimes with transrectal ultrasound at the time of prostate biopsies, a bone scan or magnetic resonance imaging (MRI) scan. If the cancer is confined to the prostate, the stage is 'T1' or 'T2', if it is outside the prostate it is 'T3' or 'T4'. Bone scans indicate whether there is cancer in the bones. Sometimes, the lymph nodes in the pelvis are sampled laparoscopically to determine if cancer is present there.
  • PSA: the higher the PSA, the more likely the cancer is outside the prostate; the faster the rate of change, the more likely serious cancer is present

Other bits of information can be used and relate often to the information gained from the prostate biopsies: the proportion of positive biopsies, the length of cancer in the biopsies or the percentage of the core with cancer.

It is important to know how the cancer was detected i.e. by screening with a PSA test or because of symptoms. Most of our knowledge is based on prostate cancer detected in patients with urinary symptoms. If the cancer was detected early because of PSA testing, the time between diagnosis and the development of symptoms from the cancer is likely to be longer than if the cancer was detected because of urinary symptoms or another medical reason.

What additional tests or scans are necessary now I have prostate cancer?

These tests relate mostly to determining if the cancer is confined to the prostate and what chance there is that treatment will fail after a few years. It is possible to combine the information to calculate whether the cancer has spread outside or the chance that the cancer will return after treatment. The information required is

  • PSA
  • Gleason Score
  • Clinical stage determined by examination of the prostate by a finger
  • the proportion of positive biopsies, the total length of biopsy cores with prostate cancer and without cancer in the biopsies 

The following web sites contain 'calculators' enabling you estimate your risk. This information should be interpreted with a doctor who understands prostate cancer.

Other investigations, such as magnetic resonance imaging (MRI) can help tell if the cancer is has spread outside the prostate and give information about your anatomy relevant to treatment and side-effects. For this test, you enter a scanning machine, which makes a lot of noise, and produces high quality images of the prostate. It may help determe if the lymph nodes ('lymph glands') contain cancer or not. Sometimes, lymphotropic superparagmagnetic particles are used (this is still under trial). The best way to tell is by laparoscopic lymph node sampling, which is a keyhole procedure for obtaining tissue to examine under the microscope. This is a highly specific test for the identification of cancer in the lymph nodes.