Should the PSA or DRE results be abnormal, a doctor may advise you to go for a biopsy to confirm or rule out the diagnosis of prostate cancer.
A biopsy is a procedure where a small piece of tissue is removed from the prostate gland for examination under a microscope. This procedure is performed by a urologist, who specialises in prostate problems and other urinary tract diseases. The urologist often uses a transrectal ultrasound (TRUS), which is inserted through the anus, to take tissue samples from several areas of the prostate gland. Some urologists may use magnetic resonance imaging (MRI) to guide the biopsy. Another biopsy approach is ultrasound-guided transperineal prostate biopsy, which is often performed under general anaesthesia. In the transperineal prostate biopsy, the biopsy needles are passed through the perineal skin and into the prostate.
During the microscopic examination, a Gleason score is given if the tissues from the biopsy confirm the prostate cancer diagnosis. This score is based on how many cells in the cancerous tissue that look different from the normal prostate cells. The total Gleason score ranges from 6 to 10. The higher the score, the more likely the cancer will grow and spread rapidly. For instance, scores of 8 and higher describe cancer cells that are poorly-differentiated (very different from normal prostate cells) and are likely to spread more quickly.
If prostate cancer is diagnosed, it is important to find out whether cancer cells have spread within the prostate gland or to other parts of the body (metastasis). Imaging tests can confirm and provide information about the cancer’s location and extent of spread. This process is known as staging.
Staging is performed using bone scan, magnetic resonance imaging (MRI) or computed tomography (CT) scan. These imaging tests are done to help doctors to plan for the best treatment option. Nevertheless, asymptomatic patients with low-risk, early stage prostate cancer may not require a CT scan or bone scan for staging.
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