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When your physician found your PSA of 6.3 ng/ml, you were referred to a urologist. The urologist performed a prostate biopsy, which is an outpatient office procedure in which 8-12 small needles are inserted into your prostate and tiny cores of tissue are removed from all areas of the gland.16,17 The prostate is divided into halves and needles are inserted into the top (base), middle and bottom (apex) of each half of the prostate. One to two biopsies will be obtained from each of these six areas, the medial and lateral (inside and outside). Each of the needle cores should be placed in a separate container and labeled by its location within the prostate.

All of the prostate cores should be sent to a pathologist who processes the material and examines the biopsy needle cores under a microscope. The pathologist’s findings will be described in a written report, called the prostate biopsy pathology report, which will be returned to your urologist. You should get a copy, read it and understand the report.

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Your prostate biopsy pathology report is the key to understanding your particular case of prostate cancer. It is far more important than PSA, stage, bone scans or anything else. The information in the pathology report tells doctors how fast your cancer is growing, how extensive it is within the prostate, and the likelihood of capsule penetration (leakage of cancer cells outside the prostate). The pathology report is the cornerstone to tailoring treatment to the extent and aggressiveness of your prostate cancer, as well as to the calculation of your 10-year ICR.

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Clinical stage of cancer is determined only by physical examination of the prostate called a DRE (digital rectal examination).  The purpose of staging is to locate the cancer, but this is often inaccurate. In fact, compared to the PSA and Gleason score, staging of prostate cancer is the most inaccurate measure of the extent of your cancer. The biggest area of inaccuracy concerns stages T1 and T2 disease, the stages that most men have. In reality, onethird or more of men with stage T1 or T2 prostate cancer actually have stage T3 prostate cancer, cancer outside the prostate, due to microscopic capsule penetration of cancer cells, which cannot be detected before treatment.

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