With that initial diagnosis of prostate cancer, you hear a host of unfamiliar terms such as staging and Gleason scores. What do they mean?

When you're hit with the words prostate cancer, you also receive a barrage of new terms: Gleason scores, staging, 3+4=7, T2b, T1c. These strange words and calculations go hand-in-hand with how doctors will approach your prognosis and treatment. Some of it's guesswork, of course, but it's important to comprehend these descriptives so you can be a part of your treatment team.

Staging and Grading

Prostate cancer is awarded with a stage and a grade. When visiting other specialists, which you should, you want to be armed with this information.

Staging gives physicians a stab at the extent of the cancer. Now less used, the Whitmore-Jewett staging works with an A,B,C,D system. The newer TNM system provides information on chances that the cancer is either contained - or not - to the prostate gland. Levels range from T1-T4 plus the letters "N," indicating possible lymph node involvement, and "M," which means spread beyond the gland capsule.

Grading is given to the core samples taken during a biopsy. One core, for instance, might be only 5% or 10% cancerous, while additional cores may be negative or show a higher incidence. You'll hear that a score of 6, meaning a 3+3, is relatively slow growing while 4+3 could be interpreted as aggressive. On the other hand, a 3+4 is still on the better side of the graph. These are your Gleason scores.

Confused? Yes! Especially when you're still a newbie, trying to adjust to this prostate cancer concept. The freight train has already hit. Now, it's time to understand where you sit with this dreaded disease.

Gleason Grading

When a biopsy is performed several tissue samples are acquired. The number of samples taken can range from 6 to 10 or 12 or more. Each sample is evaluated closely and given a grade.

When a pathologist views the cores from your biopsy, he or she is looking for specific configurations. The cells within a prostate gland exhibit distinctive patterns. Those that are cancerous begin to aggregate with particular personalities. These are judged on the Gleason scale of 1-5, with "1" being normal and the "5" being most significant. During this review, each core is studied. The two most prominent - primary and secondary - Gleason scores are added together for a potential of 10.

Gleason grading is more complicated than this, however. A score of "7" is not equal on all counts. As stated in the beginning of this article, a "3+4" is generally better than a "4+3." If a larger concentration of grade "4" areas are seen, then it is given the primary position. More prominent accumulations of grade 3 areas will take the lead over a 4.

In general, a "6" indicates that prostate cancer may be slow and contained. Some "7" scores, as we've said, mean the same, while others indicate aggressive behavior. Gleason scoring certainly helps determine a course of action.

Keep in mind, however, that a biopsy is not a guarantee of exact numbers. Often, cancerous tissue is completely missed with the needle biopsy. Rarely, a false-positive occurs. A second consideration is that reading the tissue samples is subjective. One pathologist may list a core as "suspicious" while a second opinion might render a more solid diagnosis.

On the next page, we're ready to tackle staging...