PROSTATE CANCER PATHOLOGY REPORT

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After your prostate biopsy, the tissue samples are analyzed by a pathologist to determine whether cancer is present.

Results are typically available within about one week.

This report provides critical information that helps guide the next steps—but it can also be confusing at first glance. Our goal is to help you clearly understand what it means.

The Gleason score is the most important part of your biopsy report.

It is a grading system used to estimate how aggressive the cancer may be.

• The scale ranges from 6 to 10
• 6 = least aggressive (low risk)
• 10 = most aggressive (high risk)

In reality, most prostate cancers fall between Gleason 6 and 8.

Gleason scores are usually written as a combination of two numbers, such as:

• 3 + 3 = 6
• 3 + 4 = 7
• 4 + 3 = 7
• 4 + 4 = 8

Here’s what matters:

• The first number represents the most common pattern seen
• The second number represents the next most common pattern

 This is why 3+4 and 4+3 are not the same

• 3+4 → less aggressive
• 4+3 → more aggressive

That distinction plays an important role in treatment decisions.

Some pathology reports also use a newer system called Grade Groups, which simplifies the Gleason score:

• Grade Group 1 → Gleason 6 (3+3)
• Grade Group 2 → Gleason 7 (3+4)
• Grade Group 3 → Gleason 7 (4+3)
• Grade Group 4 → Gleason 8 (4+4)

This system is often easier for patients to follow.

Your Gleason score helps guide what type of treatment—if any—is appropriate.

• Often considered low risk
• Many patients are good candidates for:
  • Active surveillance
  • Monitoring without immediate treatment

• Considered intermediate risk
• Most cases require treatment
• Often suitable for:
  • Focal (targeted) therapies
  • Less invasive treatment approaches

• Considered higher risk
• Typically requires more definitive treatment, such as:
  • Surgery (radical prostatectomy)
  • Radiation therapy

In select cases, targeted or focal therapy may still be considered with appropriate planning.

Your pathology report may include additional findings:

• Intraductal or cribriform patterns
  → May indicate a higher likelihood of aggressive disease
• Perineural invasion
  → Commonly reported, but often does not significantly change management on its own

Biopsy results are not just about numbers—they need to be interpreted in the context of:

• Your MRI findings
• PSA history
• Overall health and goals

The most important step is not just receiving the report—
it’s understanding what it means for you.