Diagnosis
In order to finally confirm the diagnosis of prostate cancer, a biopsy is required, i.e. a sample is taken from the prostate gland and examined microscopically for degenerated cells. This is carried out if the palpation finding at the DRU was conspicuous, the PSA value exceeds 4ng/ml or a rapid increase in the PSA value could be observed. During the biopsy, 10 to 12 tissue samples are taken from the prostate under TRUS control.
The whole procedure is painless for the patient. The collected material is then processed and examined for cancer cells by a pathologist. The pathologist then determines the type of tumor and the degree of malignancy, the so-called grading according to the Gleason Score.
Grading/Gleason Score
Grading is the determination of the malignancy of tumor cells. The pathologist assesses the deviations of the tumor cells from healthy cells of the prostate and assigns them to a scale, the so-called Gleason score. A distinction is made between highly differentiated cells, which differ relatively little from healthy tissue, and low differentiated cells, which show a high degree of degeneration.
The Gleason score is used to quantify the degree of degeneration. The pathologist can assign a one for very slightly differentiated cells to a five for very severely degenerated cells. This is done for two tissue samples from the prostate with different degrees of degeneration and the individual values are added together. The lowest value for the Gleason score is therefore a 2 (1+1), the highest correspondingly a 10 (5+5). This classification is of crucial importance for further therapy.
Staging/TNM Classification
Staging refers to the determination of tumor spread. This is classified using the TNM system. The “T” stands for the size of the actual tumor, “N” for the infestation of lymph nodes (nodes) and “M” for any metastases that may be present.
T0 formally stands for a non-existent tumor, T1 for a prostate carcinoma that is not clinically recognizable, T2 for a prostate carcinoma that is confined to the prostate, T3 for a prostate carcinoma that has already broken through the organ capsule and T4 finally for a prostate carcinoma that has already attacked neighboring organs. In lymph node infestation, a distinction is only made between no infestation (N0) and an infestation of the local lymph nodes in the pelvic region (N1). The metastases are classified analogously with M0 for no metastases and M1 for existing metastases.
An X after the respective letter means that this parameter could not be assessed more closely. In addition, there are other subcategories, but this rough classification is sufficient for a first orientation. This classification is also of decisive importance for the further therapy of prostate cancer.
