Prostate Mapping is a modern prostate biopsy method
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Current Methods of Diagnosis

Prostate biopsy

Prostate biopsy is a standard method of detecting prostate cancer. Prostate cancer affects thousands of men every year. It is usually detected when a man has a blood test, called a 'prostate specific antigen', or PSA, that is higher than the usual level for his age. However, because PSA can be raised in inflammation, infection and in large prostates, it is not a reliable indicator of the presence of prostate cancer. For this reason, men with a raised PSA are usually advised to undergo a prostate biopsy.

A prostate biopsy is carried out under local anaesthetic with an ultrasound scanning probe in the back passage, or rectum. A biopsy needle is inserted through the lining of the back passage and between 6 and 14 samples of tissue are taken. As ultrasound is not very good at picking up cancer, the biopsies are taken throughout the gland but in a random fashion. You have a 1 in 4 chance of having prostate cancer if you have raised PSA.

Biopsies of the prostate carried out in this way can be negative in up to 20% of men who actually have cancer. This is because such biopsies miss large areas of the prostate such as the ends of the prostate as well as areas high up in the prostate.

Prostate biopsies can also give incorrect information about how aggressive the prostate cancer is. 20% of men have more aggressive disease than detected on prostate biopsy. Over half of men have more areas of cancer than detected by prostate biopsy. These things are important to know as they can help you and your doctor come to the right decision about how to treat your prostate cancer.

If you have a prostate biopsy, the information you will get is:
  • how many biopsies of the prostate were taken
  • is there cancer in the prostate biopsy?
  • how many prostate biopsies were involved with prostate cancer?
  • how much cancer is there in each biopsy?
  • how aggressive is the prostate cancer? In other words what is the Gleason score?

The Gleason Score

The Gleason score is a measure of how aggressive the cancer cells look under the microscope. Three numbers are given, such as 3+3=6, 3+4=7, 4+3=7, 4+4=8, 4+5=9 or 5+4=9. The first number refers to the grade that is more widespread than the second grade. The higher the total score, the more aggressive the prostate cancer is. The higher the total score, the more likely it is that the prostate cancer may have spread outside the prostate and therefore aggressive treatment is needed.

Has the Cancer Spread outside the Prostate?

The first question is whether the prostate cancer has spread. Your doctor will advise you as to whether you need to undergo more tests to make sure the prostate cancer has not spread outside of the prostate. If you have a low PSA blood test and low Gleason tumour you will probably not be advised to have any further tests as the prostate cancer is likely to be confined to the prostate gland.

Usually, men are advised to have further tests after a prostate biopsy such as an MRI scan or bonescan to see if there has been any spread outside the prostate, if one of the following is present:
  • PSA greater than 10 ng/ml
  • Gleason score 7 or higher
  • rectal examination shows up an irregular feeling prostate
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