If you have been diagnosed with advanced prostate cancer, you may have had some or all of the following tests or procedures:

Digital Rectal Examination (DRE) – This allows your doctor to feel the size of the prostate and check if there are any abnormalities. Occasionally a cancer can be felt this way, but not always. A normal DRE exam does not rule out prostate cancer.

Blood test (Prostate Specific Antigen – PSA) – It identifies whether there has been an increase in a protein in your blood which indicates you need further investigation by a specialist.

If you’re not seeing one already, your GP may refer you to a urologist, a specialist in diseases of the urinary tract and male reproductive organs. The urologist will then order the following tests to confirm prostate cancer and to see if it has spread beyond the prostate:

Biopsy

A small amount of tissue from the prostate is removed and sent to a laboratory for testing by a pathologist. A biopsy is the only way a firm diagnosis of prostate cancer can be made.

Bone scan

A scanning test to find out if the cancer has spread to the bones.

CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) scan

These scans, done by a radiologist, take pictures to find out if the cancer has spread to other parts of the body.

The healthcare team looks at all the results of these tests together to gain an overall picture of the prostate cancer and to see if it is at an advanced stage. It is only then that the correct treatment options can be discussed with you.

For some men, there is sometimes no evidence of disease spreading to other parts of the body (either through a bone scan or a CT scan) but their PSA rises even after they have had treatment. The rising PSA is a form of progression showing the disease is active, known as ‘biochemical progression’.

Medicare covers some of the costs of procedures and tests used to diagnose prostate cancer, but there may be some ‘out-of-pocket’ costs. Your doctor can answer your questions about why you need certain procedures and tests and so you can prepare for any financial outlays.

Talk to a member of your healthcare team (e.g. social worker) about what financial and practical support services are available. Talk to your local Medicare office about the ‘Medicare Safety Net’ and the ‘Pharmaceutical Benefits Scheme Safety Net’ on costs of medications and medical bills (www.humanservices.gov.au/medicare-safety-net and www.humanservices.gov.au/pbs-safety-net).


Grading and staging of advanced prostate cancer

The biopsy and procedures such as a bone scan or a CT scan provide information about the grade and stage of the cancer. The grade of the cancer shows how fast the cancer may grow. The stage shows how far it has spread. Information about the grade and stage of the prostate cancer will help you talk with your healthcare team about treatment options that are appropriate for you.
Grading and staging is determined by using the Gleason Score and the Tumour-Node-Metastasis (TNM) System.


Grading: the Gleason Score

Normal tissue has an ordered pattern of growth but in cancer tissue, the pattern is not ordered because of the unpredictable way cancer cells grow. The Gleason scoring system is used to show how abnormal or different the cancer tissue is, when compared with the normal tissue. The two most common patterns of growth seen in the biopsy sample are each given a number from 1 to 5, and then these two numbers are added together to give the Gleason grade (e.g. 4+3=7). The greater the difference from the normal tissue pattern, the higher the Gleason Score, and the more aggressive the cancer acts in the body.

Cancer cells on the Gleeson grade scale
- from 1 (least aggressive) to 5 (most aggresive)

Diag 5Gleason Score


Staging: the Tumour-Node-Metastasis (TNM) System

The standard TNM system is used to determine the stage of the cancer – that is, how far it has spread from the prostate. The TNM system has three scores:

T (tumour) stage

By doing a digital rectal examination (DRE), your doctor can feel if the tumour is in the prostate or whether it has spread just outside the prostate and into nearby areas. An MRI scan can also be used for this purpose.

N (node) stage

This shows if the cancer has spread to nearby lymph nodes in the pelvic region. A CT or MRI scan is used for this purpose.

M (metastasis) stage

This shows if the cancer has spread to other parts of the body such as bones. A bone scan is used for this purpose.

This information combined with your Gleason score informs decisions about the best treatment approach.

Listed below are some questions you may want to ask members of your healthcare team about your diagnosis:

  • What are my results? What do they mean?
  • What is my biopsy result? What does it mean?
  • What is the stage of my prostate cancer? Please explain it to me?
  • What is my Gleason Score? Can you please explain it to me?

These are not the only questions to ask, there may be others that are more useful for you. The important thing is to get information so you understand the diagnosis.

Prostate cancer tumour stages
Diag 2a -T1

T1 - The tumour or cancer cannot be felt by the doctor during examination

Diag 2b - T2

T2 - The cancer can be felt but it has not spread outside of the prostate

Diag 2c - T3

T3 - The cancer has spread outside of the prostate into nearby tissues

Diag 2d - T4

T4 - The cancer has spread into nearby organs such as the bladder