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.

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.

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.

No. Another cause for PSA elevation is a prostate disease called benign prostate hyperplasia (BPH) or enlarged prostate. BPH is the most common prostate disease in men and is present in half of men age 60 or older. BPH, not cancer, is the reason men have difficulty with urination such as a weak, slow urine stream because the urethra tube is squeezed by the enlarged prostate. Inflammation of the prostate, called prostatitis can also cause PSA elevation above normal.

No. A lot of people think this, but this is not correct. Prostate cancer can spread to other parts of the body; thus, prostate cancer cells any place in a man’s body produce PSA whether they are located in bone, lung, prostate, lymph nodes or any other area. A prostate cancer cell in a man’s left shoulder makes the same amount of PSA as one in his prostate. Thus, a PSA test checks for prostate cancer throughout a man’s body, but PSA gives no information about where the cancer cells are located.

Unfortunately, no. Some prostate cancers make very little PSA and are called low-PSA producing cancers. Often, these are men with high Gleason scores indicating more aggressive cancers. Low-PSA producing cancers can be advanced and fool doctors. We discover low-PSA producing cancers based on digital rectal examination through palpation of a cancer. Additionally, these cancers can be discovered by measuring PSA velocity. Even though a man’s PSA may be within normal limits, if the PSA is progressively rising, for example 0.5 ng/ml to 1.0 ng/ml to 1.8 ng/ml in less than a year, this rise should alert doctors to the possibility of prostate cancer.