If a tumor is found, tests must be performed to determine its location, malignancy, and stage of development.

• Biopsy – A biopsy is performed with the patient lying on his side with his knees brought up to his chest. A biopsy needle is inserted through the perineum into the tumor. A probe, guided by TRUS, is inserted into the rectum to help the physician properly place the needle, which is projected through the tip of the probe. A cell sample is extracted from one or several areas of the tumor into the syringe. A pathologist then analyzes the sample to determine the type of tumor and whether or not it is cancerous.

• Gleason score – The biopsy sample is examined under a microscope for cells or groups of cells that are markedly different from healthy tissue. The greater the disparity between the healthy and malignant cells, the more likely the tumor is aggressive and will metastasize.

The pathologist examines two tissue samples taken from different areas of the tumor and assigns a score of 1 to 5 to each sample. The more abnormal the tissue, the higher the score. The sum of the two produces the Gleason score. Gleason scores of 2 to 4 indicate that the cells are well differentiated, meaning the tissue is not too abnormal; 5 to 7 moderately differentiated; 8 to 10 poorly differentiated. Higher scores suggest aggressive tumors that likely require aggressive treatment.

* Diagnosis information obtained from the urologychannel website.