Advanced Technology to Detect and Diagnose Prostate Cancer

Innovative Techniques for Prostate Biopsy

Biopsy is necessary to make the diagnosis of prostate cancer. At UH we offer biopsy both under local anesthesia in the doctor’s office or under sedation (twilight sleep).

A prostate biopsy is a procedure in which multiple tissue samples are taken from the gland and studied under a microscope by a specially trained doctor called a pathologist.

Obtaining biopsy samples of the prostate tissue may be done using one of two approaches, both of which are performed using MRI imaging guidance, when appropriate. At UH, we have one of the most pre-eminent prostate imaging groups in the country with extensive, globally recognized expertise in prostate MRI - an imaging test that looks for suspicious areas in the prostate before proceeding with biopsy. If there is an area of suspicion, the information provided by the scan allows physicians to target the area of concern to obtain tissue samples.

What Happens After the Biopsy?

Once the tissue samples have been collected, they are sent to a pathologist who will examine them under a microscope. If prostate cancer cells are found, the pathologist will assign a grade to the cancer.

There are 2 grading systems currently in use:

Gleason Score. To determine a Gleason score, the pathologist looks at each tissue sample taken during a prostate biopsy under a microscope. Each sample is assigned two numbers: one which ranks the most common cells seen, and one which ranks the second most common cells seen. The grading numbers range from 1-5. The two grades added together provide the Gleason score for each tissue sample. Scores can range from 6-10 with 6 being low grade, 7 intermediate grade and 8-10 high grade.

Grade Group System. A simpler grading system put in place by the World Health Organization in 2014 to replace the Gleason Score. With this system, tissue samples are assigned a grade ranging from 1 (low) to 5 (high).

Your healthcare provider may report your score using one or both of these methods.

Based upon your PSA, Gleason score and staging information, patients are assigned a risk group - from low to high risk - together these will help your doctor determine next steps.

Grade Group and Gleason Score Comparison Chart

Additional Diagnostic Tests for Prostate Cancer

If prostate cancer is found and depending on the type and grade of prostate cancer you have, you may need additional testing to pinpoint the location of the cancer and determine if it has metastasized (spread) beyond the prostate gland. These may include:

CT Scan

CT imaging looks at blood flow and the anatomy of tissues in and around the prostate. The information obtained can assist in diagnosis as well as the monitoring of tumor growth. CT is generally used if other test results suggest that the cancer has spread outside of the prostate.

Radionuclide Bone Scan

This nuclear imaging scan can show whether the cancer has spread to the bones. A small amount of radioactive material is injected into the body and, during the scan, any cancer cells present in the bones will be highlighted.

PET Scan

At University Hospitals, we are at the forefront of developing new and innovative imaging techniques for the detection of prostate cancer, including advanced positron emission tomography (PET) scans. There are two types of PET scans we may use:

• PSMA PET Scan. Prostate-specific membrane antigen is a protein that is over-expressed by prostate cancer tumors. During a PSMA PET scan, the patient is injected with a radioactive tracer drug that attaches to PSMA proteins. Areas where the tracer concentrates indicates the presence of cancer and will show up on the PET scan images. This new technique has been shown to provide more precise detection of tumors not only in the prostate but also throughout the pelvis and the body if the cancer has spread. This scan may also help guide new therapeutic agents for men with metastatic disease. University Hospitals is among the first hospital systems in the country to offer PSMA PET Scans.
• Axumin® PET Scan. Auxumin (Fluciclovine F 18) is an injectable diagnostic imaging agent that can help doctors get more accurate information about the location of disease in patients with recurrent prostate cancer. Used in combination with PET scan, the Auxumin is injected about 3-5 minutes before the scan begins - during this time, the agent travels through the bloodstream and into the cancer cells. Areas where the Auxumin has accumulated will light up on the scan images, showing your doctor where the recurrent prostate cancer is located. The scan itself takes from 20-30 minutes.

What is TNM Staging?

TNM stands for Tumor, Node and Metastasis. Your cancer will be assigned a number for each of the three letter components, broken down as follows:

Tumor

• T1 - the tumor cannot be felt by rectal exam, is not visible on imaging tests and is typically discovered during prostate biopsy or surgery for other reasons.
• T2 - the tumor is completely contained within the prostate gland and is visible on imaging test. The tumor may or may not be palpable by rectal exam.
• T3 - the cancer has broken through the covering of the prostate gland and possibly spread to the seminal vesicles (the tubes that carry semen).
• T4 - the cancer has spread into other nearby body organs, such as the rectum, bladder or the pelvic wall.

Node

• N0 - cancer cells are not found in nearby lymph nodes.
• N1 or N+ - cancer cells are found in the pelvic lymph nodes.

Metastatic

• M0 - the cancer has not spread (metastasized).
• M1 or M+ - the cancer has spread to distant locations, including the bones, viscera and lymph nodes outside the pelvis.

There are many different ways to treat prostate cancer. Your UH team will develop a personalized treatment plan for you based on many different factors, including the type/stage of cancer you have.