Understanding Your Pathology Report: Prostate Cancer

What is a pathology report?

A pathologist is a doctor who specializes in diagnosing diseases by examining tissue from the body. You will probably never meet the pathologist, but samples of your prostate tissue that are removed during surgery or biopsy will be sent to the pathologist for review. He/she prepares a detailed summary of the findings, which is called the pathology report.

You should obtain a copy of your pathology report for your personal health records and to share with other physicians involved in your care. Understanding this report will help you in making treatment decisions.

What will you find on a pathology report?

The information contained in the report depends on whether the specimen is submitted from a biopsy (in which case “cores” of prostate tissue are received) or from a prostatectomy, which will include the entire prostate gland, seminal vesicles, vas deferens and lymph node(s). The report is broken down into a few sections, including some information about the patient, diagnosis (if known), procedure, a description of what was received by the pathologist and a description of what is seen under the microscope (a type of cancer, benign tissue, other tissue abnormalities). For any sections containing prostate cancer, the pathologist will identify the Gleason grade and score, as well as how much of the sample contained cancer. While all reports will contain the necessary information, the way they are presented varies greatly. To help you read your report, let’s go through each of these sections individually.

The report will include the date the specimen was collected and when it was received in the laboratory. It may or may not include some information about the patient’s diagnosis and the procedure that was performed (biopsy, prostatectomy).

Types of Specimens

When a prostate biopsy is performed, the physician takes 10 or more samples from multiple areas of the prostate gland using one of two biopsy methods. The most commonly used method is the transrectal biopsy, which uses a small ultrasound probe inserted in the rectum to guide the biopsy needles through the rectal tissue into the prostate. The second method is the transperineal biopsy, which is performed by inserting needles through the perineum (the skin between the scrotum and rectum) into the prostate tissue. The specimens submitted with a biopsy are referred to as “cores”, which are cylindrically shaped pieces of prostate tissue removed by the needles. The prostate is shaped like a chestnut and surrounds the urethra, which urine drains through. The cores are taken from the top (apex), middle, and bottom (base) portions of both lobes (sides) of the gland.

In the case of a prostatectomy, the entire prostate gland is removed along with surrounding fat and tissue. The specimen may include the seminal vesicles (glands that produce about 60% of semen volume) and the vas deferens (the tube that carries semen to its destination). The specimen may also contain one or more lymph nodes.

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