It should be clear by now that pathology reports vary in large part because the clinical features they analyze often require some subjective interpretation. This means it’s important to question the findings and make sure you understand them before you make any decisions about treatment.
Start by studying your pathology report closely. Circle anything that doesn’t make sense to you. Let your doctor know how much you know, and ask questions until you are satisfied that you understand the report and both the pathologist’s and your physician’s thinking.
In particular, look for information about the location and extent of your cancer. If the information is not available in the report, find out why. If your report appears to be incomplete or has not been closely examined or explained, do not hesitate to get a second opinion or request a second biopsy.
Table 1 provides some suggestions about what questions to ask. Although it may feel uncomfortable at first to question your doctor, keep in mind that learning the answers will help you work with your doctor to make the best treatment decisions. After all, you are the one who has to live with the consequences.
Table 1: Questions to ask about your pathology report
|Questions to ask||Why you need to know|
|What is the Gleason score?||This is one of the most important factors in determining whether the tumor is confined to the prostate and how aggressive the cancer is. See Table 1 in “Understanding your prostate pathology report” for a simple risk assessment.|
|How many cores were taken during my biopsy?||Six cores were once standard, but concern about whether this practice missed cancers has led to changes in how biopsies are done. Controversies remain.The consensus among experts is that it’s better to take 10 to 12 cores during a standard biopsy, in order to sample more of the prostate. When a patient is considered at high risk for cancer, based on either PSA level or the results of a previous biopsy, some medical centers do saturation biopsies, sometimes involving as many as 20 or more cores.|
|What areas of the prostate were the cores taken from?||Ideally, prostate biopsies take cores from both sides of the prostate (bilateral sampling) and from particular regions on each side of the prostate. Not only does this increase the likelihood that the biopsy will sample enough areas of the prostate to provide a definitive diagnosis, but, if cancer is found, knowing where the cores were taken from will help determine prognosis and guide treatment.|
|What percentage of the cores were positive (had cancer cells)?Of the positive cores, what percentage of the tissue consisted of cancerous cells?||Answers to these questions can provide information about how extensive the cancer is and the likelihood that it has spread beyond the prostate. (The raw data are fed into statistical models, or nomograms, that predict the extent of cancer and the probability of progression.) This information will also help determine treatment.|
|What about neuroendocrine differentiation and small cell components?||These may signal a more advanced cancer. Neuroendocrine differentiation may also help predict hormone refractory disease (disease that no longer responds to hormone therapy).|
|Were there any additional comments and what do they mean?||Your pathologist may use this section to note observations such as atypical (equivocal) findings that could indicate that a repeat biopsy should be performed because cancer can’t be ruled out.|
|Was high-grade PIN identified?||High-grade PIN is a precancerous condition that raises the likelihood of finding cancer on a future biopsy. If high-grade PIN is found, discuss with your doctor the best time frame for returning for a follow-up biopsy.|
|How will you use the information in the pathology report to guide my treatment?||The more you understand, the more you will play an active role in determining the best course of action every step of the way.|
Originally published Oct. 1, 2007; last reviewed April 27, 2011.