You need to know what your pathology numbers are and get your doctor to explain your numbers to you, the patient. You need to understand your pathology because the pathology will affect the treatment that you get.

The DRE and PSA tests can reveal the presence of a prostate problem, but can't say whether its cause is cancer or another condition. (For information about these tests, go to Prostate Cancer Key Point # 1. If these tests do indicate a prostate problem, the doctor may ask for further diagnostic tests to find the cause.  These tests could include:

• Transrectal ultrasound (TRUS; also called endorectal ultrasound): A small probe inserted into the rectum sends out ultrasound waves (sound beyond the range of human hearing) that bounce off the prostate. A computer uses these echoes to create a picture (or "sonogram") of the prostate.
• Cystoscopy: Using a cystoscope (a thin, telescope-like instrument with a fiber-optic lighting system and a special lens), the doctor looks directly into the urethra and bladder.
• Intravenous pyelogram (IVP): This is a form of x-ray that uses a special dye, injected into a vein, to make it easier to see abnormalities in the urinary system. 
• Biopsy: This is the removal of tissue that is then examined in the lab to look for cancer cells. It is the only conclusive way to diagnose cancer.

If the tests show cancer in the prostate, the cancer will be "graded" and "staged."

The grade denotes how aggressive the cancer is, that is, how fast it is likely to grow and spread in the future.  There are several ways to measure aggressiveness, but the most common is the "Gleason Score."  The pathologist (the doctor who examines tissue removed during a biopsy for the presence of cancer cells) gives each area of cancer a grade from 1 to 5, with 1 being the least aggressive.  The Gleason Score is the two most common grades added together.  Therefore, Gleason Scores range from 2 to 10.  The higher the score, the more aggressive the cancer.

The stage denotes how large the cancer is and how much it has already spread.  One or more tests may be needed to determine the stage.  Most are "imaging" tests, that is, tests that create pictures of areas inside the body to show if cancer is there. These include x-rays, bone scans, CT (or "CAT") scans, MRI, and ultrasound.  A lymph node biopsy (examining tissue removed from the lymph nodes) will show if cancer has spread to the lymph nodes.

The grade and stage usually determine the type of treatment recommended. 

Getting a diagnosis of prostate cancer is, to say the least, a disturbing experience.  You will want to learn all you can about your condition so you can make smart decisions about your medical care. But shock and stress can make it hard to react, hard to think of everything you want to ask the doctor – and hard to process the answers. Here are some helpful tips:

• Make a list of questions before a medical appointment.
• During an appointment, take notes or use a tape recorder to help you remember the details.
• Bring a family member or friend with you to the doctor – to take notes, to ask additional questions and take part in the discussion, or just to listen.
• Get a second opinion about your diagnosis and treatment options. Some insurance companies require one; others may cover it if you or your doctor asks for it.