How to Read Your Medical Reports

Chapter Opening — David's Story

David was 63 years old when his primary care doctor told him his PSA was "a little elevated." A few weeks later, he had an MRI, then a biopsy. Over the next month, David received a stack of reports — lab results, an MRI report, a pathology report, and eventually a staging summary. Each one was filled with abbreviations, numbers, and medical jargon that felt like a foreign language.

"I'm an engineer," David said. "I solve problems for a living. But when I looked at my medical reports, I felt completely lost. What's a PI-RADS 4? What does Gleason 3+4 mean? Is my PSA of 8 bad or terrible? I didn't know what questions to ask because I didn't even understand the vocabulary."

David's radiation oncologist sat with him for thirty minutes and walked him through every report, line by line. "That one conversation changed everything," David recalled. "Once I understood what the reports were actually saying, I could participate in my own care. I went from being a passive patient to an active partner."

This chapter is that conversation — a plain-language guide to reading and understanding the medical reports you will encounter on your prostate cancer journey.

Part 1: Why Understanding Your Reports Matters

Your medical reports are the foundation of every decision made about your care. They determine your risk group, your stage, your treatment options, and how your doctors monitor your progress. Yet most patients never fully understand what these reports say.

You do not need to become a doctor to read your reports. But understanding the key elements — what the numbers mean, what the terms describe, and what is important versus what is routine — will help you:

• Ask better questions during appointments
• Understand why your doctors recommend certain treatments
• Participate meaningfully in shared decision-making
• Catch errors (which do happen — reports are created by humans)
• Reduce anxiety by replacing the unknown with understanding

This chapter covers the five main types of reports you will encounter: lab reports (PSA and blood work), MRI reports, biopsy and pathology reports, imaging reports (PET scans, CT scans, bone scans), and post-treatment surveillance reports.

Part 2: The PSA Report — Your Most Frequent Blood Test

PSA (prostate-specific antigen) is a protein produced by prostate cells — both normal and cancerous. A PSA blood test measures the amount of this protein in your blood, reported in nanograms per milliliter (ng/mL).¹ ²

What you will see on the report:

• Total PSA — The main number, reported in ng/mL. This is the value your doctor discusses most often.
• Reference range — The lab will list a "normal" range, typically 4.0 ng/mL. However, there is no single cutoff that perfectly separates cancer from no cancer.¹ ² ³
• Free PSA and % Free PSA — If ordered, this measures the portion of PSA that is not bound to proteins. A lower percentage of free PSA (below ~25%) is associated with a higher risk of cancer.⁴
• PSA density — Your PSA divided by your prostate volume (measured on ultrasound or MRI). A density above 0.15 ng/mL/cm³ raises concern, especially in men with larger prostates where a higher total PSA may simply reflect more prostate tissue, not cancer.⁵

How to interpret your PSA:

There is no magic number. PSA can be elevated for many reasons besides cancer — an enlarged prostate (BPH), infection (prostatitis), recent ejaculation, vigorous exercise, a recent catheter, or even a long bike ride.¹ ² Conversely, some men with prostate cancer have a "normal" PSA. In the Prostate Cancer Prevention Trial, 15.2% of men with PSA levels below 4.0 ng/mL were found to have prostate cancer on biopsy, though only 2.3% had clinically significant disease.⁶

Age-adjusted PSA ranges (approximate medians):⁷

• Ages 40–49: median ~0.5–0.7 ng/mL
• Ages 50–59: median ~0.7–1.0 ng/mL
• Ages 60–69: median ~1.0–1.5 ng/mL
• Ages 70–79: median ~1.5–2.5 ng/mL

Men with PSA above the median for their age group are at higher risk.⁷

PSA velocity and doubling time:

• PSA velocity — How fast your PSA is rising over time, measured in ng/mL per year. A rapid rise is more concerning than a stable elevation.
• PSA doubling time (PSADT) — The time it takes for your PSA to double. A short doubling time (e.g., 3 months) after treatment is associated with a higher risk of aggressive disease and cancer-specific mortality.⁸ ⁹

Medications that affect PSA:

• Finasteride and dutasteride (5-alpha reductase inhibitors used for BPH or hair loss) can reduce PSA by approximately 50%. Your doctor must account for this when interpreting your results.¹⁰
• Testosterone replacement therapy (TRT) can increase PSA. Men on TRT need regular PSA monitoring.

Key takeaway: A single PSA number in isolation tells you very little. The trend over time, the rate of change, your prostate size, your age, your medications, and your overall clinical picture all matter. Always ask your doctor to explain your PSA in context.

Part 3: The MRI Report — Mapping Your Prostate

If your PSA is elevated or your doctor suspects prostate cancer, a multiparametric MRI (mpMRI) of the prostate is typically the next step before biopsy. The MRI provides detailed images of the prostate and surrounding structures.¹¹ ¹²

What the MRI report includes:

1. Prostate size and volume

The report will list the dimensions of your prostate (length × width × height in centimeters) and the calculated volume (in cubic centimeters or milliliters). A normal prostate is roughly 20–30 cc in a younger man but can grow to 60, 80, or even over 100 cc with BPH. Prostate volume is important for calculating PSA density.

2. Zonal anatomy

The prostate has distinct zones:

• Peripheral zone (PZ) — The outer part of the prostate, closest to the rectum. About 70–80% of prostate cancers arise here.
• Transition zone (TZ) — The inner part that surrounds the urethra. This is where BPH develops. Cancers here can be harder to detect on MRI.
• Central zone — A smaller area near the base of the prostate.

The report will describe findings by zone because the MRI scoring criteria differ between zones.¹³

3. PI-RADS score — The most important number on your MRI report

PI-RADS stands for Prostate Imaging Reporting and Data System. It is a standardized 1-to-5 scoring system that tells your doctor how suspicious a lesion looks for clinically significant prostate cancer.¹³ ¹⁴ ¹⁵

• PI-RADS 1 — Very low suspicion (clinically significant cancer is highly unlikely)
• PI-RADS 2 — Low suspicion (clinically significant cancer is unlikely)
• PI-RADS 3 — Intermediate suspicion (equivocal — the presence of clinically significant cancer is uncertain)
• PI-RADS 4 — High suspicion (clinically significant cancer is likely)
• PI-RADS 5 — Very high suspicion (clinically significant cancer is highly likely)

What do these scores mean in practice? A large meta-analysis of PI-RADS version 2.1 found the following approximate cancer detection rates for clinically significant prostate cancer:¹⁴ ¹⁵

• PI-RADS 1: ~3–6%
• PI-RADS 2: ~5–6%
• PI-RADS 3: ~19–20%
• PI-RADS 4: ~53–54%
• PI-RADS 5: ~83–84%

Generally, PI-RADS 1–2 lesions are not biopsied. PI-RADS 4–5 lesions are almost always biopsied. PI-RADS 3 is the "gray zone" — your doctor will consider additional factors (PSA density, biomarkers, clinical history) to decide whether biopsy is needed.¹⁶ ¹⁷

How PI-RADS scoring works:

The scoring is based on different MRI sequences:¹³

• In the peripheral zone, the primary sequence is diffusion-weighted imaging (DWI), which measures how water molecules move through tissue. Cancer restricts water movement, appearing as a bright spot on DWI and a dark spot on the ADC (apparent diffusion coefficient) map.
• In the transition zone, the primary sequence is T2-weighted imaging, which shows anatomy. Cancer appears as a dark, irregular area distinct from the typical nodular pattern of BPH.
• Dynamic contrast-enhanced (DCE) imaging can upgrade a PI-RADS 3 lesion to PI-RADS 4 in the peripheral zone if there is early, intense enhancement.

4. Extraprostatic extension (EPE) and seminal vesicle invasion (SVI)

The MRI report will comment on whether cancer appears to extend beyond the prostate capsule (EPE) or into the seminal vesicles (SVI). These findings affect staging and treatment planning. MRI has moderate sensitivity (~60%) but high specificity (~90%) for detecting EPE.¹⁸

5. Lymph nodes

The report will note whether any pelvic lymph nodes appear enlarged or suspicious. Normal lymph nodes are typically less than 8–10 mm in short axis.

6. Incidental findings

MRI may reveal findings unrelated to prostate cancer — kidney cysts, hernias, bone lesions, or other abnormalities. These are usually noted at the end of the report and may require separate follow-up.

Key takeaway: The PI-RADS score is the single most important number on your MRI report. A score of 4 or 5 means a biopsy is strongly recommended. A score of 1 or 2 is reassuring. A score of 3 requires a conversation with your doctor about next steps.

Part 4: The Pathology Report — The Definitive Diagnosis

If you undergo a prostate biopsy, the tissue samples are sent to a pathologist — a doctor who examines cells under a microscope. The pathology report is the most important document in your prostate cancer journey because it provides the definitive diagnosis and grade of your cancer.¹⁹ ²⁰ ²¹

What the pathology report includes:

1. Specimen identification

Each biopsy core is labeled by location — for example, "right base," "left mid," "right apex," or "targeted lesion #1." A standard biopsy takes 12 systematic cores (6 from each side) plus additional targeted cores if MRI-suspicious lesions were identified.¹⁹ ²²

2. Diagnosis

The pathologist will report one of the following for each core:

• Benign prostatic tissue — No cancer found
• Adenocarcinoma — The most common type of prostate cancer (>95% of cases)
• High-grade prostatic intraepithelial neoplasia (HGPIN) — Abnormal cells that are not cancer but may indicate cancer nearby. A single focus of HGPIN does not usually require immediate re-biopsy, but multiple foci may.²³
• Atypical small acinar proliferation (ASAP) — Suspicious cells that are not definitively cancer. This typically warrants a repeat biopsy.
• Intraductal carcinoma of the prostate (IDC-P) — A pattern strongly associated with aggressive cancer. When found alongside invasive cancer, it indicates higher risk.²³ ²⁴

3. Gleason score and Grade Group — The grading system

This is the most critical part of your pathology report. The Gleason score describes how the cancer cells look under the microscope — specifically, how different they are from normal prostate gland architecture.¹⁹ ²⁰ ²¹ ²⁵

The pathologist assigns two Gleason pattern numbers (each ranging from 3 to 5):

• Pattern 3 — Well-formed, individual glands. The cells still look somewhat like normal prostate tissue.
• Pattern 4 — Poorly formed, fused, or cribriform (sieve-like) glands. The normal architecture is breaking down.
• Pattern 5 — No recognizable gland formation at all — sheets of cells, single cells, or areas of dead tissue (necrosis).

The Gleason score is the sum of the two most prominent patterns. For example:

• Gleason 3+3 = 6
• Gleason 3+4 = 7
• Gleason 4+3 = 7
• Gleason 4+4 = 8
• Gleason 4+5 = 9
• Gleason 5+5 = 10

Why the order matters: A Gleason 3+4 = 7 is NOT the same as a Gleason 4+3 = 7. The first number represents the predominant (most common) pattern. A 3+4 means mostly well-formed glands with some poorly formed areas — this is less aggressive. A 4+3 means mostly poorly formed glands with some well-formed areas — this is more aggressive.²⁰ ²¹ ²⁵

The Grade Group system simplifies this into five groups:²⁰ ²¹ ²⁵ ²⁶

• Grade Group 1 (Gleason ≤6) — Low risk. Many experts now consider this "not truly cancer" in the traditional sense, as it has an extremely low risk of spreading.
• Grade Group 2 (Gleason 3+4 = 7) — Favorable intermediate risk. Mostly well-formed glands.
• Grade Group 3 (Gleason 4+3 = 7) — Unfavorable intermediate risk. Mostly poorly formed glands.
• Grade Group 4 (Gleason 8) — High risk. Aggressive cancer.
• Grade Group 5 (Gleason 9–10) — Very high risk. The most aggressive form.

4. Number and percentage of positive cores

The report will state how many of the biopsy cores contain cancer (e.g., "4 of 12 cores positive"). It will also report the percentage of each core involved with cancer (e.g., "60% of the core length"). More positive cores and higher percentages generally indicate more extensive disease.²⁰ ²²

5. Perineural invasion (PNI)

This means cancer cells are growing along or around nerves within the prostate. PNI on biopsy may suggest a higher likelihood of extraprostatic extension, though its independent prognostic significance is debated.²³ ²⁴

6. Lymphovascular invasion (LVI)

Cancer cells found within blood vessels or lymphatic channels. This is less commonly reported on biopsy but, when present, suggests a higher risk of spread.²³

A note on second opinions:

Pathology interpretation is subjective — different pathologists may assign different Gleason scores to the same tissue. Studies show that approximately 25–30% of cases are upgraded or downgraded on expert re-review, and in some cases the changes are clinically significant.²⁷ It is entirely reasonable — and often encouraged — to seek a second pathology opinion from a major academic center, especially if the result will change your treatment decision.

Key takeaway: The Grade Group (1–5) is the single most important number on your pathology report. It directly determines your risk category and treatment options. Make sure you understand your Grade Group and ask your doctor to explain what it means for your specific situation.

Part 5: The Staging Report — Putting It All Together

Once you have your PSA, MRI, pathology, and any additional imaging, your doctors combine all of this information to determine your stage — a standardized description of how far the cancer has spread. Prostate cancer uses the TNM staging system developed by the American Joint Committee on Cancer (AJCC).²⁸ ²⁹

T — Tumor (how far the primary tumor has grown):²⁸

• T1 — The tumor cannot be felt on exam or seen on imaging
• T1a: Found incidentally in ≤5% of tissue removed during a TURP
• T1b: Found incidentally in >5% of tissue removed during a TURP
• T1c: Found by needle biopsy because of elevated PSA (this is the most common scenario today)
• T2 — The tumor can be felt on DRE but is still confined within the prostate
• T2a: Involves half of one side or less
• T2b: Involves more than half of one side
• T2c: Involves both sides
• T3 — The tumor has grown beyond the prostate capsule
• T3a: Extraprostatic extension (EPE)
• T3b: Invasion into the seminal vesicle(s)
• T4 — The tumor has invaded adjacent structures (bladder, rectum, pelvic wall, sphincter)

N — Nodes (regional lymph node involvement):²⁸

• N0 — No cancer in regional (pelvic) lymph nodes
• N1 — Cancer found in regional lymph nodes

M — Metastasis (distant spread):²⁸

• M0 — No distant spread
• M1 — Cancer has spread to distant sites
• M1a: Non-regional lymph nodes (outside the pelvis)
• M1b: Bone metastases
• M1c: Other organs (liver, lung, etc.)

AJCC Stage Groups:²⁹

The TNM categories are combined with PSA and Grade Group to assign an overall stage:

• Stage I — T1–T2a, Grade Group 1, PSA 10
• Stage II — Confined to the prostate but with higher PSA or Grade Group
• IIA: Grade Group 1 with PSA 10–20 or T2b–T2c
• IIB: Grade Group 2
• IIC: Grade Group 3 or 4
• Stage III — Higher risk features
• IIIA: PSA ≥20 (any Grade Group 1–4)
• IIIB: T3–T4 (tumor extends beyond prostate)
• IIIC: Grade Group 5
• Stage IVA — Any T, N1 (lymph node involvement)
• Stage IVB — Any T, any N, M1 (distant metastases)

Key takeaway: Your stage is not just one number — it combines tumor extent (T), lymph node status (N), distant spread (M), PSA, and Grade Group. Understanding your stage helps you understand why your doctors recommend specific treatments.

Part 6: The NCCN Risk Group — What Drives Your Treatment

While the AJCC stage is important, most treatment decisions in prostate cancer are driven by the NCCN risk group classification, which categorizes localized prostate cancer into risk groups based on clinical T stage, Grade Group, and PSA.³⁰ ³¹

• Very Low Risk — T1c, Grade Group 1, PSA 10, fewer than 3 positive cores with ≤50% involvement in each, PSA density 0.15
• Low Risk — T1–T2a, Grade Group 1, PSA 10
• Favorable Intermediate Risk — 1 intermediate risk factor (T2b–T2c, Grade Group 2 or 3, or PSA 10–20), AND Grade Group 1 or 2, AND 50% cores positive
• Unfavorable Intermediate Risk — 2–3 intermediate risk factors, OR Grade Group 3, OR ≥50% cores positive
• High Risk — T3a, OR Grade Group 4 or 5, OR PSA >20
• Very High Risk — At least two of: T3–T4, Grade Group 4 or 5, PSA >40

Each risk group has different treatment recommendations. For example, very low and low risk patients are often candidates for active surveillance, while high and very high risk patients typically need more aggressive treatment with radiation plus hormone therapy, or surgery.³⁰ ³¹

Key takeaway: Ask your doctor: "What is my NCCN risk group?" This single classification drives most treatment decisions and is more clinically useful than the AJCC stage alone for localized disease.

Part 7: PET Scan Reports — Finding Cancer Beyond the Prostate

If your cancer is intermediate-risk or higher, or if you have a recurrence after treatment, your doctor may order a PET scan — most commonly a PSMA-PET/CT or PSMA-PET/MRI.³² ³³

What is PSMA?

PSMA (prostate-specific membrane antigen) is a protein found on the surface of prostate cancer cells. Radioactive tracers that bind to PSMA are injected into your bloodstream, and a PET scanner detects where the tracer accumulates — highlighting areas of prostate cancer throughout the body.³² ³³

FDA-approved PSMA tracers include:³³

• Ga-68 PSMA-11
• F-18 piflufolastat (DCFPyL)
• F-18 flotufolastat (rhPSMA-7.3)

What the PET report includes:

1. Primary tumor findings — The tracer uptake in the prostate, described by location and intensity (often measured as SUVmax — standardized uptake value maximum). Higher SUVmax generally correlates with higher-grade cancer.³⁴

2. Lymph node findings — Any lymph nodes with abnormal tracer uptake, described by location (pelvic, retroperitoneal, etc.) and size.

3. Bone findings — Any skeletal sites with abnormal uptake. The report will specify locations (e.g., "L3 vertebral body," "right iliac bone," "left 7th rib").

4. Other organ findings — Uptake in liver, lungs, or other soft tissues.

Important caveats about PSMA-PET:³² ³³ ³⁵

• Not all PSMA uptake is cancer. Normal PSMA uptake occurs in the kidneys, bladder (because the tracer is excreted in urine), salivary glands, liver, spleen, and small bowel. Your doctor knows to ignore these.
• False positives exist. Benign conditions such as bone healing (fractures), inflammation, and certain benign tumors can show PSMA uptake.
• False negatives exist. Some prostate cancers do not express PSMA (approximately 5–10%), and very small tumors may be below the detection threshold.³⁵
• PSMA-PET should be done before starting hormone therapy (ADT), as ADT can affect detection sensitivity.³²

Other PET tracers you may encounter:³³

• F-18 fluciclovine (Axumin) — An amino acid-based tracer, primarily used for biochemical recurrence
• C-11 choline — An older tracer, less sensitive than PSMA
• F-18 sodium fluoride (NaF) — A bone-specific tracer
• F-18 FDG — The standard PET tracer used in most other cancers; NOT routinely useful in prostate cancer except in some advanced castration-resistant cases

Bone scan reports:

A traditional technetium-99m bone scan may still be ordered. The report will describe areas of increased uptake ("hot spots") in the skeleton. Not all hot spots are cancer — arthritis, old fractures, and degenerative changes can also cause uptake. Your doctor will correlate bone scan findings with other imaging and clinical information.

CT scan reports:

A CT scan of the abdomen and pelvis may be ordered to evaluate lymph nodes and organs. The report will describe lymph node sizes, any organ abnormalities, and bone findings visible on CT. CT is generally not sufficient to evaluate the prostate gland itself.³²

Key takeaway: PSMA-PET is the most sensitive imaging tool for detecting prostate cancer spread, but it is not perfect. False positives and false negatives occur. Always discuss PET findings with your doctor in the context of your full clinical picture.

Part 8: Post-Treatment PSA Reports — What to Expect

After treatment, PSA becomes your primary surveillance tool. But the expected PSA behavior differs dramatically depending on whether you had surgery or radiation.³⁶ ³⁷ ³⁸

After radical prostatectomy (surgery):³⁶ ³⁷ ³⁸

Because the entire prostate gland is removed, PSA should drop to undetectable levels (typically 0.03 ng/mL) within 6–8 weeks. Any detectable PSA after surgery raises concern:

• PSA persistence — PSA never becomes undetectable after surgery. This may indicate residual cancer (local or distant).
• PSA recurrence (biochemical recurrence) — PSA was undetectable but then becomes detectable and rises on two or more consecutive measurements, or rises above 0.1 ng/mL.³⁸ ³⁹
• A stable, very low PSA (e.g., 0.1 ng/mL that does not rise) may indicate retained benign prostate tissue rather than cancer.³⁷

After radiation therapy:³⁶ ³⁷ ⁴⁰

Because the prostate is still in place after radiation, PSA does NOT drop to zero. Instead, it falls slowly over months to years, reaching a lowest point called the nadir. The target nadir is ideally below 1.0 ng/mL, and lower nadirs are associated with better outcomes.³⁷

• PSA bounce — A temporary rise in PSA (usually within the first 2 years after radiation) that then comes back down on its own. This is NOT recurrence. It occurs in up to 30–40% of patients, is more common in younger men, and can cause significant anxiety. The key is that a bounce is self-limited — the PSA rises and then falls again without treatment.³⁷
• Biochemical recurrence (Phoenix definition) — A PSA rise of ≥2 ng/mL above the nadir. This is the standard definition used after radiation.⁴⁰ However, your doctor may investigate a rising PSA trend even before this threshold is reached, especially if you are young and healthy.⁴⁰

After hormone therapy (ADT):³⁷

PSA should decline after starting ADT, typically reaching very low levels within 6–8 weeks. The depth of the PSA decline has prognostic value — achieving a nadir below 0.1 or 0.2 ng/mL is associated with better outcomes. A rising PSA on ADT suggests the cancer is becoming castration-resistant.

PSA monitoring schedule:³⁶

• Every 6–12 months for the first 5 years after definitive treatment
• Annually thereafter if PSA remains stable
• More frequent monitoring (every 3 months) may be needed for high-risk patients or those with a rising PSA

Key takeaway: The expected PSA pattern after treatment depends entirely on what treatment you received. After surgery, PSA should be undetectable. After radiation, PSA falls slowly and a temporary bounce is normal. A rising trend is always worth discussing with your doctor, but not every rise means recurrence.

Part 9: The Surgical Pathology Report — After Prostatectomy

If you undergo radical prostatectomy, the entire prostate gland is sent to pathology for a comprehensive examination. This report is more detailed than the biopsy report and may change your risk assessment.²⁰ ²⁷

Key elements of the surgical pathology report:

1. Final Gleason score and Grade Group

The Grade Group on the surgical specimen may differ from the biopsy. Studies show that approximately 30–50% of cases are upgraded or downgraded compared to the biopsy.²⁷ This is because the pathologist can now examine the entire gland rather than just small needle samples.

2. Pathologic T stage (pT)

Unlike the clinical T stage (based on DRE and imaging), the pathologic T stage is based on what the pathologist actually sees under the microscope:²⁸

• pT2 — Cancer confined to the prostate (organ-confined)
• pT3a — Cancer extends through the prostate capsule (extraprostatic extension)
• pT3b — Cancer invades the seminal vesicle(s)
• pT4 — Cancer invades adjacent structures

3. Surgical margins

• Negative margins (R0) — No cancer cells at the inked edge of the specimen. This is the goal.
• Positive margins (R1) — Cancer cells are present at the cut edge, meaning cancer may have been left behind. A positive margin does not guarantee recurrence, but it increases the risk and may prompt consideration of additional treatment (secondary radiation therapy).³⁹

4. Lymph node status

If a pelvic lymph node dissection was performed, the report will state how many lymph nodes were removed and how many contained cancer (e.g., "2 of 18 lymph nodes positive for metastatic adenocarcinoma").

5. Tumor volume

Some reports estimate the total volume of cancer within the prostate, which can provide additional prognostic information.

Key takeaway: The surgical pathology report is the most accurate assessment of your cancer. If the Grade Group is higher than the biopsy suggested, or if margins are positive, your doctor may recommend additional treatment such as radiation therapy.

Part 10: Genomic Test Reports — Molecular Profiling

You may receive a report from a genomic test performed on your biopsy or surgical tissue. These tests analyze the activity of specific genes to provide additional prognostic information beyond what traditional pathology can offer.

Common genomic tests in prostate cancer:

Decipher (GenomeDx) — Analyzes 22 genes to produce a score from 0 to 1. Higher scores indicate higher risk of metastasis. Categories: low risk (0.60). Used after biopsy or surgery to help guide treatment decisions.⁴¹

Oncotype DX Genomic Prostate Score (GPS) — Analyzes 17 genes to produce a score from 0 to 100. Used primarily in low and favorable intermediate risk disease to help decide between active surveillance and treatment.

Prolaris — Measures cell cycle progression genes to estimate cancer aggressiveness. Produces a score that predicts 10-year mortality risk.

Artera (formerly Decipher GRID) — A newer platform that integrates genomic data with clinical information for treatment recommendations.

Key takeaway: Genomic tests provide additional information that can help you and your doctor make more personalized treatment decisions, particularly in borderline cases where the best course of action is uncertain.

Part 11: Common Abbreviations You Will Encounter

Medical reports are filled with abbreviations. Here is a quick reference guide:

Lab and clinical:

• PSA — Prostate-specific antigen
• DRE — Digital rectal examination
• BPH — Benign prostatic hyperplasia
• PSADT — PSA doubling time
• LUTS — Lower urinary tract symptoms

Pathology:

• GS — Gleason score
• GG — Grade Group
• ISUP — International Society of Urological Pathology
• HGPIN — High-grade prostatic intraepithelial neoplasia
• IDC-P — Intraductal carcinoma of the prostate
• PNI — Perineural invasion
• LVI — Lymphovascular invasion
• ASAP — Atypical small acinar proliferation

Imaging:

• mpMRI — Multiparametric magnetic resonance imaging
• PI-RADS — Prostate Imaging Reporting and Data System
• DWI — Diffusion-weighted imaging
• ADC — Apparent diffusion coefficient
• DCE — Dynamic contrast-enhanced imaging
• PSMA — Prostate-specific membrane antigen
• PET — Positron emission tomography
• SUVmax — Maximum standardized uptake value
• EPE — Extraprostatic extension
• SVI — Seminal vesicle invasion

Staging and treatment:

• TNM — Tumor, Node, Metastasis staging system
• AJCC — American Joint Committee on Cancer
• NCCN — National Comprehensive Cancer Network
• RP — Radical prostatectomy
• RT — Radiation therapy
• EBRT — External beam radiation therapy
• ADT — Androgen deprivation therapy
• BCR — Biochemical recurrence
• CRPC — Castration-resistant prostate cancer
• CSPC — Castration-sensitive prostate cancer
• nmCRPC — Non-metastatic castration-resistant prostate cancer
• mCRPC — Metastatic castration-resistant prostate cancer
• OS — Overall survival
• PFS — Progression-free survival
• MFS — Metastasis-free survival
• BRFS — Biochemical recurrence-free survival
• HR — Hazard ratio
• CI — Confidence interval
• AE — Adverse event
• CTCAE — Common Terminology Criteria for Adverse Events
• QoL — Quality of life
• ECOG PS — Eastern Cooperative Oncology Group Performance Status

Part 12: How to Spot Errors in Your Reports

Medical reports are created by humans, and errors do happen. Being an informed reader can help you catch mistakes that could affect your care.

Common errors to watch for:

• Patient identification — Always verify that the report has your correct name, date of birth, and medical record number. Mix-ups between patients, while rare, do occur.
• Laterality errors — Check that "right" and "left" are consistent throughout the report. If your MRI shows a PI-RADS 5 lesion on the right side, the biopsy cores from the right side should be the ones showing cancer.
• Specimen labeling — Verify that the number of cores reported by the pathologist matches the number your urologist said were taken. If 14 cores were taken but only 12 are reported, ask about the discrepancy.
• Inconsistencies between reports — If your MRI says the prostate is 45 cc but your ultrasound report from the same week says 80 cc, one of them may be inaccurate. Large discrepancies are worth questioning.
• Copy-paste errors — In electronic medical records, portions of prior reports are sometimes copied into new reports. Look for outdated information that does not match your current situation.

What to do if you find an error:

• Do not panic — most errors are clerical and do not affect your care
• Contact your doctor's office and ask for clarification
• Request a formal amendment to the report if the error is clinically significant
• Keep your own organized file of all reports so you can cross-reference

Part 13: Building Your Personal Medical File

One of the most empowering things you can do as a patient is to maintain an organized file of all your medical reports. This is especially important if you see multiple doctors, seek second opinions, or move between healthcare systems.

What to keep in your file:

• All PSA results with dates (create a simple spreadsheet or table tracking PSA over time)
• MRI reports and images (request a CD or digital access)
• Biopsy pathology reports
• Surgical pathology reports (if applicable)
• PET scan, CT scan, and bone scan reports
• Genomic test results (Decipher, Oncotype, Prolaris, etc.)
• Treatment summaries (radiation treatment summary, surgical operative report, medication lists)
• A list of your doctors with contact information
• Insurance authorization letters and correspondence

Tips for organizing:

• Use a three-ring binder with dividers by category, or a digital folder system
• Keep reports in chronological order within each category
• Highlight or tab the key findings (Grade Group, stage, PSA values)
• Bring your file to every appointment — it saves time and ensures accuracy
• Many hospital systems now offer patient portals where you can access your reports electronically. Learn how to use yours.

Creating a PSA tracking chart:

A simple table or graph tracking your PSA over time is one of the most useful tools you can create. Include the date, PSA value, and any relevant notes (e.g., "started ADT," "completed radiation," "had UTI"). This visual trend is often more informative than any single number.

Part 14: Questions to Ask When You Receive a Report

You do not need to understand every word of every report. But you should always feel comfortable asking your doctor these key questions:

For any report:

• "Can you walk me through the main findings?"
• "Is there anything unexpected or concerning?"
• "Does this change my treatment plan?"
• "Do I need any additional tests based on these results?"

For PSA results:

• "What is my PSA trend over time?"
• "What is my PSA density?"
• "Is this level expected given my treatment?"

For MRI reports:

• "What is my PI-RADS score?"
• "Does the MRI show any signs of cancer extending beyond the prostate?"
• "Do I need a biopsy based on this MRI?"

For pathology reports:

• "What is my Grade Group?"
• "How many cores are positive and what percentage is involved?"
• "Should I get a second pathology opinion?"
• "Would a genomic test help clarify my risk?"

For staging and PET reports:

• "What is my clinical stage?"
• "What is my NCCN risk group?"
• "Is there any evidence of spread to lymph nodes or bones?"
• "Are there any findings that need further investigation?"

For post-treatment reports:

• "Is my PSA where it should be at this point?"
• "Could this PSA change be a bounce rather than recurrence?"
• "When should I have my next PSA check?"

Questions to Ask Your Doctor

1. "Can you explain my pathology report to me in plain language?"
2. "What is my Grade Group and what does it mean for my prognosis?"
3. "What is my NCCN risk group, and how does it affect my treatment options?"
4. "Should I seek a second opinion on my pathology?"
5. "How often should I have my PSA checked, and what number would concern you?"
6. "Can you help me understand my imaging results — what did the PET scan or MRI show?"
7. "Is there a patient portal where I can access my reports electronically?"
8. "Would a genomic test add useful information in my case?"

Myth vs. Fact

Myth: "A PSA of 4 means I have cancer."

Fact: PSA of 4 ng/mL is a commonly used threshold for further evaluation, but many men with PSA above 4 do not have cancer, and some men with cancer have PSA below 4. PSA is a screening tool, not a diagnostic test.¹ ² ⁶

Myth: "Gleason 6 is a dangerous cancer that needs immediate treatment."

Fact: Grade Group 1 (Gleason 6) has an extremely low risk of spreading or causing harm. Many experts now advocate that it should not even be called "cancer." Active surveillance is the recommended approach for most men with Grade Group 1 disease.²⁰ ²⁵ ²⁶ ³⁰

Myth: "If my PET scan is negative, I definitely don't have cancer."

Fact: No imaging test is 100% sensitive. PSMA-PET can miss very small tumors, cancers that do not express PSMA, and disease in areas of high background uptake. A negative PET scan is reassuring but does not guarantee the absence of cancer.³² ³³ ³⁵

Myth: "A rising PSA after radiation always means the cancer is back."

Fact: PSA bounces — temporary rises followed by spontaneous declines — occur in up to 30–40% of men after radiation and are NOT recurrence. The Phoenix definition of biochemical recurrence requires a PSA rise of ≥2 ng/mL above the nadir.³⁷ ⁴⁰

Myth: "I don't need to understand my reports — that's my doctor's job."

Fact: While your doctor interprets the reports, understanding the basics empowers you to ask better questions, participate in shared decision-making, catch potential errors, and reduce anxiety. You are the most important member of your healthcare team.

Key Takeaways

1. Your medical reports are the foundation of every treatment decision. Understanding the basics — PSA trends, PI-RADS scores, Grade Groups, and staging — empowers you to participate actively in your care.
2. The Grade Group (1–5) is the single most important number on your pathology report. It directly determines your risk category and treatment options. A second pathology opinion is reasonable, especially in borderline cases.
3. PSA behavior after treatment depends on the treatment received. After surgery, PSA should be undetectable. After radiation, PSA falls slowly and temporary bounces are normal. Context matters more than any single number.
4. No imaging test is perfect. PSMA-PET is the most sensitive tool available, but false positives and false negatives occur. Always interpret imaging in the context of your full clinical picture.
5. Keep an organized personal medical file. Track your PSA over time, save all reports, and bring your file to every appointment. Being organized reduces errors and improves communication with your medical team.

Support Resources

• National Cancer Institute — Understanding Your Pathology Report: Prostate — cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports — Plain-language guide to prostate cancer pathology reports
• Prostate Cancer Foundation — pcf.org — Educational materials on diagnosis, staging, and treatment
• ZERO — The End of Prostate Cancer — zerocancer.org — Patient guides and educational videos
• MyProstateCancerRoadmap.com — Interactive tool for understanding your diagnosis and treatment options
• NCCN Patient Guidelines for Prostate Cancer — nccn.org/patients — Free patient-friendly version of the NCCN clinical guidelines
• UsTOO International — ustoo.org — Peer support and educational resources
• Patient Advocate Foundation — patientadvocate.org — Help with accessing medical records and navigating the healthcare system

References

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