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Posing Questions about Your Prostate Biopsy

If you have any questions about the results of your biopsy, whether it's positive or negative for cancer, be sure to write them down so that you can remember to discuss them with your doctor.

If the biopsy is positive for cancer

Here are some questions to ask your doctor in the event that the findings are positive for prostate cancer:

  • What is the stage of the cancer?
    The urologist will assess how far the cancer has extended, and whether it has spread beyond the prostate gland or is still localized to the prostate. Most doctors use the Tumor Node Metastasis (TNM) system to determine the stage of the cancer. The doctor may have to do more tests before he can tell you the correct stage.
  • What is the grade of the cancer in the biopsies?
    The grade of the cancer is determined by the pathologist, who looks at the biopsies through a microscope. He uses a special scale (usually the Gleason scale) to determine the grade. Grading is basically a process that provides an estimate of how chaotic or aggressive the cancer is.
  • What is the amount of cancer in the biopsies?
    The amount of cancer in the biopsies can give your doctor some indication of how much space or volume the cancer takes up inside your prostate. Tumor volume has some importance in estimating how serious the cancer is, although it's not as important as stage, grade, or PSA level.
    The doctor can't obtain an exact reading on the volume of the cancer in your prostate with a biopsy. To obtain an exact reading, the doctor needs to remove your prostate. When the prostate is removed with surgery, the pathologist calculates the actual cancer volume in the removed prostate. However, before surgery or any other type of treatment, your urologist can get a better idea of how big your cancer is by looking at how many biopsy cores are positive and/or how much of each core contains cancer.
  • How much time do I have before I need to start getting treated for prostate cancer?
    Using the grading and staging information as well as other basic information, such as your age and your overall health, your doctor gives you a recommendation for what treatment you should receive for your prostate cancer (whether it's surgery, radiation, hormone therapy, another form of treatment, or even a combination of several treatments) and when you should receive it.

In some cases, the doctor may recommend no current treatment, which is also referred to as watchful waiting. This approach is generally advised when a person has less than a ten-year life expectancy or is in poor health, or the cancer is very low risk.

If the biopsy is negative for cancer

You're much more likely to have many questions if the biopsy is positive, but you may also have some questions if the test comes out negative. For example, you may wonder if a negative test means that you're safe forever from the scourge of prostate cancer. Sadly, the answer isn't always yes. A negative biopsy means that you don't have cancer or that you don't have a very big cancer — but biopsies are only slivers of tissue, and sometimes cancer can be missed.

Whether to biopsy you again is a very complicated issue that has to do with family history (you have a greater chance of having prostate cancer when you have relatives with it, the level of your PSA and whether it's rising, and what your prostate feels like in a rectal examination. Your urologist knows about all these issues, so he can form a follow-up plan with you.

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