Your doctor will use the results of all the tests you have had to build up a picture of your cancer. This allows them to measure how far the cancer has spread and how quickly it may be growing.
The PSA test alone cannot diagnose prostate cancer. All men have some PSA in their blood, and the level of PSA naturally rises as men get older. The following figures are a rough guide to ‘normal’ PSA levels, depending on your age. PSA is measured in nanograms per millilitre of blood (ng/ml).
A PSA level higher than the normal range for your age may suggest a problem with the prostate. But a normal PSA result does not rule out prostate cancer. Similarly, if your PSA level is only slightly above the normal range for your age, this does not always mean that you have prostate cancer.
There is no upper limit for the PSA level, and some men may have a PSA level in the hundreds or thousands. Having a PSA level this high is uncommon but it is likely to suggest that a man has prostate cancer.
The PSA test is also an effective way of monitoring your prostate cancer after you have been diagnosed or had treatment, and can be used alongside other test results. You will have regular PSA tests as part of your follow-up after treatment.
A pathologist will look at your biopsy samples under the microscope. If a sample contains cancer it is ‘graded’ to show how active the cancer is. The pathologist looks at the pattern made by the cancer cells and gives that pattern a grade from 1 to 5. This is called Gleason grading.
The pathologist may see more than one grade of cancer, so the grades of the most common pattern and the pattern with the highest grade are added together. This gives your Gleason score.
For Example: If the biopsy samples show that:
Most men with prostate cancer will have a Gleason score between 6 and 10. The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread.
Staging is a way of recording how far the cancer has spread. The most common method is the TNM (Tumour-Nodes-Metastases) system.
The T stage shows how far the cancer has spread in and around the prostate gland. A digital rectal examination (DRE) can measure this. You may also have an MRI scan to confirm your T stage.
The tumour cannot be felt and can only be seen under a microscope – localised prostate cancer.
The tumour can be felt but it is contained within the prostate gland – localised prostate cancer.
The tumour can be felt breaking through the capsule of the prostate or into the seminal vesicles – locally advanced prostate cancer.
The tumour has spread to nearby organs, such as the neck of the bladder, back passage or pelvic wall – locally advanced prostate cancer.
The N stage shows whether the cancer has spread to the nearby lymph nodes. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your groin are near the prostate and are a common place for prostate cancer to spread to.
The N stage is measured using an MRI or CT scan. This stage will only be measured if the result is likely to affect your treatment options.
NX The lymph nodes were not measured.
N0 The lymph nodes do not contain cancer cells.
N1 The lymph nodes do contain cancer cells.
The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones. This is measured using a bone scan. Cancer that has spread to other parts of the body is called advanced prostate cancer. This stage may not be measured if the result is unlikely to affect your treatment options.
MX The spread of the cancer was not measured.
M0 The cancer has not spread to other parts of the body.
N1 The cancer has spread to other parts of the body.
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