(By: Dr Shital Munde, Doctor in-charge and Consultant – Histopathologist, Global Reference, Laboratory, Metropolis Healthcare Limited)


Prostate cancer is one of the most common cancers affecting men and as per Global Cancer Statistics 2022, GLOBOCAN, it is the third most common cancer diagnosed in men worldwide.


The risk of prostate cancer rises very steeply with age and as per the CDC, 66% of cases are reported in males above 65 yr of age. Cancer causes abnormal increases in the size of the prostate resulting in clinical symptoms like trouble urinating, pain, and decreased force in the stream of urine.


Detection Of Prostate Cancer


If the doctor suspects Prostate cancer, he/she may advise you multiple tests starting with a simple blood test to advanced imaging methods, and finally the biopsy for confirmation.


Blood test: The levels of Prostate Specific Antigen (PSA) are increased in cases of prostate cancer and this test is used as a preliminary screening test. If the levels are high, the Doctor will advise further imaging investigations.


Imaging: Transrectal ultrasound followed by MRI of the prostate to analyse the size of the prostate and any abnormal growth. Recently the role of Artificial Intelligence in radiology is being studied and implemented. Many clinical studies are underway which are using Deep learning–AI-based methods for the automated segmentation in MRI for the detection of suspicious or cancerous lesions in the prostate. This will help in better categorisation of prostate lesions and unnecessary invasive prostate biopsies can be prevented in false positive cases.


Biopsy: The final step in diagnosis is Prostate biopsy, this is an invasive procedure and is performed under the guidance of transrectal ultrasound. Multiple tissue samples or biopsies are taken from different areas of the prostate and sent to the laboratory where an Expert Pathologist evaluates them. The role of prostate biopsy is not only to confirm the cancer but also for the grading of cancer.


Grading Of Prostate Cancer


The treatment plan and management of prostate cancer depends upon the grading of the cancer. The grading of prostate cancer is done by an Expert Pathologist, which is based on the architecture of the tumor. 


Two methods are used in combination, The Gleason’s scoring system, which is based on the pattern of tumor cells in biopsy.
There are 5 Gleason patterns numerically categorised from 1 to 5 which represent simple to complicated patterns of tumour cells. The lowest pattern reported is 3 as patterns 1 and 2 are rarely reported. The biopsy can show a combination of any pattern and depending on two predominant or worst patterns the combined Gleason score is given, for Example score of 7 can be 3+4 or 4+3 depending on the predominant pattern. To simplify and for accurate prognostication, newer Group grading system was introduced by the International Society of Urological Pathology (ISUP).


The ISUP Grade uses a 1 to 5-grade group system, grouping the combination of Gleason scores. The higher the grade group, the higher the risk of your cancer being aggressive and spreading rapidly.  This system accurately classifies the common Gleason score of 7 in two groups depending on the predominant pattern. So, a Gleason score of 3+4 is grouped as 2 (intermediate favourable) and 4+3 is grouped as 3 (unfavourable risk).


Role Of Artificial Intelligence


Newer techniques in diagnostic laboratories such as digital whole slide imaging (WSI) have opened the platform for Artificial intelligence (AI) in prostate cancer diagnosis and grading. Multiple studies have shown promising results using deep learning for autonomous cancer detection in WSI of prostate biopsy specimens. These methods have been explored to enhance the accuracy of the Gleason grading and reduce the inter-observer bias. FDA has approved few such Deep Learning systems and few algorithms for Gleason grading are available commercially. AI has become an asset to Pathologists in improving diagnostic accuracy, standardizing grading, and ultimately optimizing patient care.


Staging Of Prostate Cancer


If the patient has prostate cancer, then the treatment plan and management depend on how far the cancer has spread. Once the grading of cancer is confirmed on biopsy, Doctors use a staging system called TNM to understand the spread of the cancer. The TNM staging of prostate cancer is based on 5 key pieces of information. The extent of the main (primary) tumour (T) – if the tumour is limited to the prostate, it has a better prognosis than tumour going into surrounding organs. The cancer spread to nearby lymph nodes (N) and to other parts of the body (metastasized) (M category) along with PSA level at the time of diagnosis and The Grade Group (based on the Gleason score) on the biopsy.


Treatment Of Prostate Cancer


The treatment for prostate cancer in its early stages is active surveillance or Surgery. The advanced stage of cancer can be treated with Surgery, Radiation therapy and radiopharmaceutical therapy, Hormone therapy, Chemotherapy, Targeted therapy, and Immunotherapy.


[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]