Frequently Asked Questions

Prostate Biopsy Pathology Report

Q: What factors are there to consider when evaluating prostate cancer?

A: When evaluating a man’s particular case of prostate cancer, there are three major factors we first consider: 1) Gleason score 2) PSA and 3) Stage.

Q: What is the most important factor to consider for prostate cancer between Gleason score, PSA and Stage?

A: By far and away, it is your Gleason score, which is found in your prostate biopsy pathology report. The Gleason score shows how fast your cancer is growing. The Gleason score system was developed by Dr. Don Gleason based upon his looking at prostate biopsies under the microscope. Basically, there are five Gleason scores: The table here shows these five Gleason scores with the percent of men that we have seen with these scores in our program in the past few years. As you can see, your Gleason score of 4+3=7 is found in 16% of all men and indicates a fairly fast growing cancer. Most men have a slower growing cancer than yours.


Q: What does 4+3=7 mean for a Gleason score?

A: Dr. Gleason assigned a number between 1-5 to the most common grade or pattern of prostate cancer he saw with the microscope. He also gave a number between 1-5 to the second most common pattern. He then added these numbers to get the Gleason score. Thus, your most common pattern is Grade 4, an aggressive prostate cancer and the next most common pattern is Grade 3, a slower form. Incidentally, Grades 1 and 2 are rarely, if ever, seen which is why the lowest Gleason score is 3+3=6.

Q: I had cancer in four needles but only one needle with Gleason score 4+3 and the other three needles with Gleason score 3+4. Why don’t I have Gleason 3+4?

A: Your Gleason score is based on the highest Gleason score number found in your biopsy, even if only in one needle. It is not based on the number of needles with a lower Gleason score.

Q: I had Gleason score 4+3 in one area of my prostate and 3+4 in another. Is this common?

A: Yes. It is very common for men to have different Gleason scores in different areas of the prostate.

Q: How was my Gleason score determined?

A: Your 12-needle biopsy, which is the standard procedure for prostate biopsy, was sent to a pathology doctor who looked at your biopsy specimens under the microscope. Then, based upon his experience, he determined your Gleason score, wrote your biopsy report and sent it to your urologist.

Figure 2. The 12 needle cores taken during prostate biopsy of Bill Smith.


Q: Am I guaranteed to have Gleason score 4+3 if that is what my results showed?

A: No and there are two reasons. First, when a 12-needle biopsy is performed, only a tiny amount of prostate tissue is removed. Thus, a needle could hit a large area of tumor and show that you have a Gleason score of 4+3. However, it is possible that you could have a small area of Gleason 4+4=8 or more that was missed. We learned this from comparing biopsy Gleason scores to men who later had a Radical Prostatectomy in which the entire prostate is studied. Fortunately, this is uncommon with the 12-needle biopsy. As for the second reason, the Gleason score determination is made by the pathologist who looked at your biopsy material. The accuracy depends on his skill and experience. Thus, pathologists can sometimes make a mistake in the Gleason score. Because of this, we always have a man’s biopsy material double checked by expert pathologists before we treat someone.

Q: How would I get my biopsy material double checked?

A: All you need to do is sign a release so we can have your biopsy material sent to us and then we send it to expert pathologists who will look at it again under the microscope and give a second opinion on your biopsy material. Most of the time, the Gleason scores will be the same but not always. Because the Gleason score is the most important issue about your particular cancer, we want it to be as accurate as possible.

RCOG second opinion prostate biopsy pathology report of Bill Smith. Pathology exam of the 12 needle cores of Figure 2.