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A Primer on Prostate Cancer: The Empowered Patient's Guide by Stephen Strum, MD & Donna Pogliano $28.95 Paperback
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Prostate & Cancer: A Family Guide to Diagnosis, Treatment & Survival by Sheldon Marks & Judd Moul MDs $17.05 from amazon.com

PCa Links :: Prostate & PSA Test :: BIOPSY:: GLEASON :: PARTIN TABLES (updated) :: Treatment

Biopsy and Your Prostate
Before You Get a Biopsy

"Free" PSA May Reduce Need for Some Prostate Cancer Biopsies
PSA Rising, May 20 1998

For Biopsy, Get Second Opinion
PSA Rising, December 9 1999

Hot Paper in The Scientist October 1997: William Catalona talks about his paper on Free PSA to reduce unnecessary biopsies.

When You Get a Biopsy

Real Pain Prostate biopsy and other procedures are often done without pain relief. this editorial asks why? Scientific American, August 2002

Gel greatly reduces prostate biopsy pain
By Lillian Kim, Emory University. Patients who received liocaine gel before the biopsy "experienced significantly less pain than those who underwent the biopsy the conventional way, without anesthetic." July 10, 2000

Biopsy and Ultrasound includes images of equipment used in prostate biopsy. The Prostate Center, Princess Margaret Hospital, University of Toronto, Ca.

Comparison of Prostate Biopsy Protocols using 3-D Computer Simulation (suggests that sextant biopsy is not as good as a 10 core biopsy: "The 10- and 12- pattern biopsy protocols had a 98.5% detection rate, whereas, the sextant biopsy protocol was only 72.8%.") John J. Bauer Walter Reed Army Medical Center and University of the Health Sciences, and others.

High Grade PIN: Benign cells found in prostate biopsy can indicate cancer ".... evidence that certain pre-malignant prostate cells might indicate current or future prostate cancer. " Article by Deborah Kuban, M.D. Eastern Virginia Medical School. ASCO Online, 1999.

Prostate Pathology Tutorial with a tables of prostate cancer staging (American Urological Society Clinical Staging) and a series of large images of biopsy slides showing normal prostate tissue, prostatitis, benign disease (BPH, or benign hyperplasia), high grade PIN, and grades of cancer (adenocarcinoma).
From The Internet Pathology Laboratory, WebPath, at medstat.med.utah

Gleason Grade & Score

A full scale DIAGRAM of the 5 Gleason grades and a useful article from CoMed is at Walter Reed Army Hospital nuclear medicine department.

The Gleason grading system (see small diagram above) named after the physician who formulated it, is a way of grading the structure of prostate tissue as seen under a microscope. Normal body tissue cells are well-formed and differentiated to meet the functions of the specific body part.

Cancer cells are always atypical in some respect. As long as the cancer is well differentiated then it looks more similar to normal cells. If the cells become progressively random and chaotic, the tumor is poorly differentiated or undifferentiated, and to a pathologist the stage of abnoramlity is visible under a microscope.

The Gleason system is based on the architectural pattern of the glands of the prostate tumor. A tumor whose structure is nearly normal (well differentiated) will probably have a biological behavior relatively close to normal -- not very aggressively malignant. The Gleason grade and score are key pieces of information for making treatment decisions.

OncoLink FAQ: Gleason Score (this site tends to be busy and may take a while to answer)

Gleason's Grading of Prostate Needle Biopsies Tutorial and Testing Web site, Johns Hopkins Pathology

Gleason Score 2 – 4 Adenocarcinoma of the Prostate on Needle Biopsy A Diagnosis That Should Not Be Made Jonathan I. Epstein, M.D. The American Journal of Surgical Pathology 24(4): 477-78, 2000 © 2000 Editorial

"This editorial proposes that Gleason scores of 2 – 4 should not be assigned to adenocarcinoma on needle biopsy because it usually represents an undergrading of higher-grade carcinoma, is not reproducibly diagnosed even by urologic pathology experts. and can adversely impact on patient care. The vast majority of tumors graded as Gleason score 2 – 4 on needle biopsy, when reviewed by experts in urologic pathology, are graded as Gleason scores 5 – 6 or higher. In a study of men coming to Johns Hopkins Hospital for radical prostatectomy, we concurred with the outside needle biopsy grade of Gleason score 2 – 4 in only four of 87 cases."

Second Opinion Centers of Excellence, Prostate Pathology

Urologic Pathology Laboratory Johns Hopkins Hospital is a nationally recognized center for prostate biopsy and study of urologic disorders. Vast expertise in the study and diagnosis of the pathology of prostate cancer. Primary consultant, Dr. Jonathan Epstein. Check the web page and call 1-800-997-5475

Bostwick Laboratories (David G. Bostwick, M.D., M.B.A.) is a pathology reference laboratory serving patients as well as physicians and managed care. Services include Primary Biopsy Interpretation; Second Opinion; DNA Ploidy Aanalysis; Immunohistochemistry (markers include p53, c-myc, and bcl-2 oncogene and tumor suppressor gene products and CD34 angiogenesis marker). Dr. Bostwick is one of the authors of the ACS book Prostate Cancer, What Every Man - and His Family - Needs to Know (1996, 1999, Villard, New York, $14.95).

The Prostate Lab (Dr. Jonathan Oppenheimer)
Second Opinion on Biopsy Slides, Biopsy Evaluation (Primary Opinion), Prognostic Evaluation of Radical Prostatectomy Specimen, Prognostic Testing (Ploidy, BCL2 p53, p27, p21) and other services.

Learn More About Biopsy

Orient yourself with Prostate Pathology 101 in the Prostate Lab run by Jonathan Oppenheimer MD:

• Understanding Your Prostate Pathology Report
• Know Your Gleason Score -- Gleason Grading
• DNA Ploidy
  

Partin Tables Use them to predict the probability that prostate cancer has spread out of your prostate into the lymph nodes on the basis of your Gleason score, your PSA value, and your clinical stage

Update 2003: Read the section on Partin Tables at Johns Hopkins and input your own stats into their "instant" calculator.

Making the Most Out of Six Systematic Sextant Biopsies by Thomas A. Stamey. M.D., Department of Urology, Stanford University, in Urology, January 1995

Drill More Holes and Find More Oil by urologist David Crawford MD. He is commenting on the article below by Calvanese. These two articles are at Medscape, which asks you to register and get a password. The site is free of charge. Although the information is aimed at medical professionals, patients/family members may find material to discuss with their physicians and support groups.

Presurgical Staging in Prostate Cancer Christina B. Calvanese. et al. Infect Urol 12(1):22-28, 1999. Says that men with seminal vesicle or lymph node metastases may benefit from aggressive therapy (surgery plus radiation, hormone replacement, or combination hormone and radiation therapy) but only if their metastases are detected before radical prostatectomy. Presents evidence for routine performance of sextant biopsies including specimens from each prostate section.