How Doctors Determine the Significance of the Prostate Cancer
Doctors estimate the significance of the cancer by estimating its stage. This means how far it has progressed. Doctors speak of two kinds of staging, clinical and pathological. Clinical staging is based on the analysis, under a microscope, of the samples of tissue taken during the needle biopsy. Pathological stage is what is found during prostate surgery, when the gland and the areas around it can be more carefully sampled. Thus, this is far more accurate. The purpose of clinical staging is to estimate the pathological stage. Staging is important because if the cancer has begun to spread beyond the capsule of the prostate, then it can no longer be cured by surgery.
The standard needle biopsy includes six cores (samples) taken from across the prostate, especially from suspicious areas seen on the ultrasound. The trend is to take more samples in hopes of improving the accuracy of clinical staging. This includes estimating how large the tumor is, by the number of cores and the percentage of each that contain cancer cells. It also includes an evaluation of whether the tumor has penetrated the capsule of the prostate gland. This is done by examining samples from the margins of the prostate for cancer cells. Staging also includes an analysis of the grade of the cancer cells, that is, how different they are from normal cells. This gives an idea of how aggressive the cancer may be. PSA level is also used to estimate the significance of the cancer. The higher the PSA, the more extensive the cancer probably is.
