The meanings of the pathological report of prostate cancer
The examination of prostate tissues is crucial for assessing men’s health, especially in cases of suspected prostate cancer. After a pathologist examines a tissue sample taken from the prostate under a microscope following special preparation, the diagnosis is communicated to the treating physician in the form of a pathology report. The information contained in this report helps determine treatment options and fundamentally influences the patient’s further fate. Understanding the diagnostic process and accurately interpreting the findings requires familiarity with the procedures for obtaining tissue samples, the terminology used in the reports, and their meanings.
Thus, the examination of prostate tissues not only serves to identify the disease but also plays a key role in selecting the appropriate treatment direction. Patients are often confused by the content of the reports, so it is important for them to understand what the various terms mean and how they affect treatment decisions.
Why and how is prostate tissue sampling performed?
Samples taken from prostate tissues are essential for establishing a diagnosis, particularly in cases of suspected prostate cancer. Prostate enlargement is often benign, but malignant changes can also occur. The clinical symptoms of the two conditions are often similar, which is why a histological examination is necessary for an accurate diagnosis. During the transurethral resection (TUR) procedure, the surgeon removes prostate tissue surrounding the urethra, allowing for detailed histological analysis.
Among the sampling procedures, the core needle biopsy is the most common, during which the urologist uses a hollow needle to take tissue samples from the prostate. This procedure typically involves 6-12 samples taken from different areas of the prostate. The histological processing of the samples allows for the identification of changes in the prostate tissue processes, provided that these changes are present in the samples. Each sample’s diagnosis is separately indicated in the pathology report, giving the treating physician a clear picture of the patient’s condition and possible treatment options.
Prostate cancer and adenocarcinoma
The most common type of prostate cancer is adenocarcinoma, which originates from the glandular tissue of the prostate. The term carcinoma refers to malignant tumors arising from epithelial cells. Cancerous cells are generally well-differentiated from healthy prostate tissue, but special histological examinations are often necessary for an accurate diagnosis. Early detection and diagnosis of adenocarcinoma are crucial for developing an appropriate treatment plan.
To determine the stage and aggressiveness of prostate cancer, the Gleason score is essential. This system takes into account the characteristics of cancerous cells observed during histological examination and classifies the severity of the tumor based on structural differences among the cells. The Gleason score ranges from 1 to 10, with higher values indicating more aggressive tumors. Doctors also use the Gleason score to determine treatment options for the tumor.
The significance of the Gleason score in diagnosis
The Gleason score is one of the most important elements in the diagnosis of prostate cancer, as it determines the behavior of the tumor and predicts the course of the disease. A Gleason score of 6 indicates low aggressiveness, while scores of 8-10 are characterized by rapid growth and spread. A score of 7 denotes a tumor of moderate aggressiveness.
The Gleason score not only defines the type and grade of the tumor but can also vary based on different samples. This means that samples taken from different areas of the prostate can yield different Gleason scores, complicating the accurate diagnosis. The treating physician can determine the necessary treatment based on the highest score.
In addition to the Gleason score, other factors influence the treatment of prostate cancer, such as PSA levels, results of the digital rectal examination, and the proportion of cancerous tissue in the samples. Together, this information assists the physician in selecting the most appropriate treatment strategy.
Special tests and other terms in the pathology report
Pathology reports often mention special tests, such as high molecular weight cytokeratin (HMWCK), AMACR, or perineural invasion. These tests aim to provide a more precise understanding of the behavior of prostate cancer cells. It is important to note that not all patients require these additional tests, and their presence does not affect the accuracy of the diagnosis.
Perineural invasion refers to the spread of cancerous cells along nerves and can increase the risk of spread beyond the prostate boundaries. Vascular invasion indicates the entry of the tumor into blood vessels, which can also suggest an unfavorable prognosis. However, the presence of perineural invasion alone does not mean that the tumor has already spread, and the Gleason score and the amount of cancerous tissue are much more critical factors in terms of treatment.
High-grade prostatic intraepithelial neoplasia (PIN) is a precancerous condition that indicates early changes in glandular tissue. This finding does not necessarily indicate the presence of prostate cancer but may alert the patient to the need for increased monitoring.
Understanding pathology reports and knowledge of histological examinations are fundamentally important in the diagnosis and treatment of prostate cancer. Patients should discuss the content of their reports in detail with their doctors to gain a clearer picture of their condition and the necessary treatments.
