Understanding what your results mean

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Understanding Your Prostate Cancer Diagnosis

YOUR RESULTS

If you have had an MRI scan and biopsy and have received a diagnosis of prostate cancer you will now have some results to consider.

These results will contain information which tells you:

  • How aggressive the cancer is, indicated by the Gleason Grade.
  • The progression, size and location of the tumour, indicated by the TNM Stage.

This page will help you to understand what these terms mean and will help you to get a clearer picture of your prostate cancer and the best treatment options for you. In almost all cases however we recommend that men seek a second opinion before accepting treatment. 

GLEASON GRADE

The Gleason Grade is used to evaluative how aggressive the cancer is and how likely it is to spread outside of the prostate.

Many people with a new diagnosis of prostate cancer will want to know their outlook and to understand the treatment options that are likely to be appropriate for them – the Gleason Grade helps to determine both of these.

 

The Gleason Grade refers to the pattern of cancer cells in the prostate.

The pattern structure of these cells indicates how quickly they are likely to grow.

The different patterns are graded 1 to 5, with Grade 1 being very similar to typical prostate tissue, and Grade 5 being very different to typical prostate tissue. Grades 3, 4, and 5 are cancer.

Prostate cancers often have areas with different grades. The Gleason Score is derived from adding the most common grade in the samples to the second highest grade. 

The first score is the most common grade in all the samples. The second is the highest grade of what is left. When these two grades are added together, the total is called the Gleason Score.

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Understanding my Gleason results

This is a finding of no cancer in the prostate gland.

This is considered early-stage prostate cancer and may not progress further or may progress slowly.

Men with this diagnosis would commonly be advised to follow the Active Surveillance protocol.

For these men HIFU Focal Therapy is a viable alternative treatment.

This is considered early-stage intermediate prostate cancer and is unlikely to cause harm in the short term.

Men may be offered Active Surveillance or radical treatments such as Radical Prostatectomy or Hormone / Radiotherapy treatment. Men under the age of 70 who are in good health are likely to be encouraged to have a Radical Prostatectomy.

Men with a Grade Group 2 prostate cancer are highly likely to be suitable for HIFU Focal Therapy and ought to consider this treatment option.

This is considered to be a higher stage intermediate disease stage and radical whole gland treatments are normally recommended.  Radical Prostatectomy or Hormone / Radiotherapy treatment. 

For a majority of men with Gleason 4 + 3 = 7  HIFU Focal Therapy is a suitable treatment option but this needs to be carefully reviewed by a Multidisciplinary team to ensure that the areas of concern can be treated fully so that the risk of recurrence is minimised. 

These are considered advanced-stage prostate cancer and men with these prostate cancers benefit substantially from radical treatments such as Radical Prostatectomy or Hormone / Radiotherapy treatment.

HIFU Focal Therapy would not be suitable in these cases.

If you have received your Gleason results and would like to discuss what they mean for your diagnosis and treatment options, call us on 020 3820 2282 and we would be happy to offer advice and information.

TNM STAGE

If conclusive, the TMN Staging system can indicate the tumour’s size, location, and whether it has spread to the lymph nodes or another part of the body (metastasis).

These results will have a combination of the letters T (tumour), N (node) and M (metastasis) and a number to indicate the stage of each, or an X if the result cannot be evaluated.

In general terms T1, T2, and some T3a tumours where the cancer is still confined within the prostate gland, can be considered for HIFU focal therapy.

Understanding my TNM stage results

The number next to the T describes the size and spread of the cancer.

T1: The cancer is too small to be felt during a digital rectal examination (DRE) of the prostate but may be visible on the MRI scan.

T2: The tumour is found only in the prostate, not other parts of the body.

  • T2a: The tumour involves one half of one side of the prostate.
  • T2b: The tumour involves more than one half of one side of the prostate, but not both sides.
  • T2c: The tumour has grown into both sides of the prostate.

T1 and T2 tumours are known as localised prostate cancer. The cure rate for localised prostate cancer is very high (above 98%). Treatment options include Active Surveillance, Radical Prostatectomy, Hormone / Radiotherapy or Focal Therapy, including HIFU Focal Therapy.

T3: The tumour has spread outside the prostate and may be growing into tissues or organs close by.

  • T3a: The prostate cancer tumour is abutting the edge of the prostate capsule and there is a risk that it may have infiltrated the wall and spread into the surrounding tissue.
  • T3b: The tumour has spread to the seminal vesicles that produce some of the fluid for semen.

T3 prostate cancer is considered to be a relatively advanced stage and radical treatment is necessary. In some cases T3a tumours can be suitable for treatment with HIFU Focal Therapy.

The number next to the N describes whether or not the cancer has spread to the lymph nodes.

N0: There is no cancer in the lymph nodes near the prostate.

N1: There is cancer in 1 or more lymph nodes close by.

NX: There is no information about the nearby lymph nodes, or they can’t be assessed. 

The number next to the M describes whether or not the cancer has metastasized, ie spread to another part of the body.

M0: The cancer has not spread to another part of the body.

M1: The cancer has spread to another part of the body.

MX: It is unknown if cancer has spread to distant sites.

For a patient to be able to consider HIFU Focal Therapy as a viable treatment option, the cancer tumour must reside only in the prostate gland and not have grown outside the prostate.

For patients whose cancer has a TNM stage of T3 or above, the tumour is also located outside of the prostate gland and is not suitable to be treated with HIFU Focal Therapy.

If you have received your TNM Staging results and would like to discuss what they mean for your diagnosis and treatment options, call us on 020 3820 2282 and we would be happy to offer advice and information.

consultant urologist talks to prostate cancer patient

QUESTIONS FOR YOUR DOCTOR

Now you have your prostate cancer diagnosis results and before starting treatment you should talk to your doctor about your options. You may want to seek a second opinion, or even talk to several doctors about all treatment options, their side effects, and the expected results.

Here are some questions to ask your doctor:

  • What are my treatment options? Which do you recommend for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment? How can the side effects be managed?
  • What can I do to prepare for treatment? 
  • Will I ned to be hospitalised? If so, for how long?
  • How will treatment affect my normal activities? Will it affect my sex life? Will I have urinary problems? Will I have bowel problems?

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At The Focal Therapy Clinic we are passionate about prostate cancer sufferers knowing about all of their treatment options.

We know that settling on the right treatment is a big decision for you. If you would like to speak to one of our friendly and knowledgeable patient advocates about your diagnosis and the HIFU Focal Therapy treatment option then please do not hesitate to get in touch today.

All enquiries to The Focal Therapy Clinic are confidential, and we are delighted to offer our advice and support with no obligation.