At your assessment visit

When you first come to our Centre you will probably have already had a prostate biopsy to confirm that you have prostate cancer and you will probably have been referred to us for an assessment to see if brachytherapy treatment is right for you.

At your first visit (your outpatient appointment) to the Centre:

We will ask you questions about any previous illnesses, operations or medications so that we have your full medical history.
We will ask you to complete a short questionnaire about your symptoms.
Click here to see the questionnaire you will be given.
You will need to have a comfortably full bladder when you arrive at the Centre as we will measure your urine flow rate when you are urinating.
We will then scan your bladder to see if there is any urine left in it.
You will have a digital rectal examination to assess the stage of your cancer
Click here to find out about the stages of prostate cancer

Click here to find out about the grades of prostate cancer

Biopsy

A biopsy is a surgical procedure in which small samples of tissue (usually 6) are removed from different parts of the prostate gland through a needle and examined under the microscope by a pathologist, a medical person specialising in identifying disease through the study of cells, tissue and organs. The procedure takes about 15 minutes and is usually performed under local anaesthetic.

The Stage of Your Cancer

The stage of your cancer refers to how far your cancer has spread. The classification commonly used to stage prostate cancer in the UK is shown here in a simplified form. (The prefix T is used to identify the tumour stage, i.e.T1 or T2). It is very important to remember that although all prostate cancers have the potential to progress, it may take many years to pass from Stage 1 to 4.

Stage 1
Earliest stage, where the cancer is so small that it cannot be felt on rectal examination, but is discovered in a prostate biopsy or in prostate tissue that has been surgically removed to "unblock" the flow of urine (as in a transurethral resection of the prostate ? TURP).
Stage 2
The tumour can now be felt on rectal examination, but is still confined to the prostate gland and has not spread.
Stage 3
The tumour has spread outside the gland and may have invaded the seminal vesicles.
Stage 4
The tumour has spread to involve surrounding tissues such as the rectum, bladder or muscles of the pelvis.

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Rectum with ultrasound probe inserted

At your assessment visit

We will also want to know about the grade of or the Gleason score of your prostate cancer.
You will have an ultrasound scan, called a transrectal ultrasound or TRUS, to assess the size and shape of your prostate gland. The pictures of your prostate we take help us decide whether brachytherapy is right for you. The pictures also help us plan where we will implant the seeds should you go on to have prostate brachytherapy treatment.

Once we have gathered all the information about you that we need, we will discuss with you what we have found out and whether we think prostate brachytherapy may be suitable for you. The final choice is yours so do not forget to ask questions if you are unsure of anything.

Brachytherapy is not the only treatment for prostate cancer, but it is as effective for suitable patients at treating the cancer as surgery (radical prostatectomy) or external beam radiotherapy. It also has a low risk of incontinence or impotence. It is important, however, that you weigh up all your treatment options before making your decision.

Gleason Score

The Gleason score is used to assess the pathological grade of prostate cancer. The grade of a cancer is the term used to describe how aggressive the disease is and whether it will progress quickly (months) or slowly (years). The grading assessment is made by a pathologist in the laboratory, looking at the prostatic cells under the microscope. The grading system used for prostate cancer is known as the Gleason Scoring system, named after the pathologist Donald Gleason, and ranges from 2–10.

The pathologist will identify several of the prostate cancer cells in the biopsy. Having identified the largest and second largest areas of cancerous cells, they will assign each area a number known as the Gleason grades. These grades range from 1–5, with grades 1–3 tumours least likely to spread and grades 4 and 5 most likely. A Gleason score greater than 6 indicates a high risk of spread.

The Gleason Score is calculated by adding the two Gleason grade numbers together – thus, the score ranges from 1+1=2 to 5+5=10. Therefore, a Gleason Score of 3+2=5 suggests that most of the cancer is Gleason grade 3, with a smaller amount of Gleason grade 2. Prostate cancers with a Gleason Score of 7 or greater will always contain at least some Grade 4 tumour and hence have a worse prognosis. Understanding of the pathological grading is of great importance for both the clinician and the patient, as it will determine which treatment options are available, as well as their likely success. Many regional cancer centres will arrange for a specialist pathologist to review the microscopic slides of a patient’s prostate cancer cells to confirm the diagnosis before treatment begins.

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