Biomarkers (Tumor Markers)

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• PSA Lab Value
• Number of Cores Examined and Positive

In addition to the standard data items found on a pathology report, information on biomarkers or genetics can also be found on the pathology report. Some of these may be found on the original pathology report (with or without an addendum), or in a separate molecular pathology report.

Biomarkers (tumor markers) can be

• Diagnostic: Aid in making diagnosis
• Predictive: Associated with response to treatment
• Prognostic: Associated with disease outcome (i.e., overall survival)

There are several data items that collect additional diagnostic or staging information relevant for Prostate. For further information on these data items, see the SSDI manual.

PSA Lab Value

The PSA is a blood test that measures the level of prostatic-specific antigen. The PSA test is used for screening purposes, assessing overall prostate health, and monitoring a patient after they’ve been diagnosed.

PSA is a protein that is made by the prostate gland and found in the blood. PSA blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia (BPH), infection or inflammation of the prostate gland. PSA screening is very common, with some hospital facilities having free PSA screening during Prostate Health Month.

In general, a PSA over 4 ng/ml can be concerning for malignancy. As noted above, the PSA level can be increased due to non-malignant conditions as well as cancer. For some men, their PSA may be normally high due to these conditions.

An elevated PSA is not a definitive diagnosis of cancer. It does lead to further workup, including an MRI, DRE, or other tests to evaluate whether a patient has cancer or not. Eventually, it may lead to a diagnostic biopsy.

• PSA should be done within 3 months of the date of diagnosis; however, Prostate has many issues that other sites may not. For Prostate cancer, surveillance, and seeking second opinions are very common, so it’s not uncommon for a patient to have an elevated PSA and to not have further workup for several months. Due to this, PSA has different coding rules for coding the lab value.
• If a PSA is done and a diagnostic biopsy follows within 3 months, then the registrar can record that PSA value. (See the SSDI PSA, Note 3 for the full instructions and multiple examples).
• In the event that a diagnostic biopsy is not done, then if the PSA is done within 3 months of the date of diagnosis, then the PSA can be used.
• See the SSDI for PSA for further instructions.

If a PSA doesn’t fit one of these criteria, then the instructions state to code the PSA Lab Value as unknown (XXX.9).

Number of Cores Examined and Positive

The Standard Transrectal Needle Core biopsy is frequently performed when a cancer diagnosis is suspected. This procedure is guided by a transrectal ultrasound (TRUS) which is a diagnostic imaging procedure that uses sound waves to create images of the prostate. For the transrectal biopsies, usually 12 cores are removed.

Another type of prostate biopsy is the transperineal biopsy, where the tissue samples are taken through the perineum instead of the rectum. This procedure offers lower risk of infection, and usually more than 12 cores are removed.

A more recent type is the MRI-guided prostate biopsy. Other names include

• MRI fusion biopsy
• Targeted biopsy
• Region of interest biopsy

During this procedure, MRI imaging, with ultrasound, is used to determine suspicious areas of the prostate and biopsy only those areas. The number of cores examined and positive during this procedure is much greater.

• For the MRI-guided targeted biopsies, registrars are to count these as 1 core examined/1 core positive. The reason for this is that recording the actual numbers would inflate the numbers.
• See the SSDI manual, Prostate Schema, Number of Cores Positive/Examined for more information.

Regardless of the type of needle biopsy performed, they all remove prostate cores. A prostate core is a small thread-like, cylinder shape tissue sample (about 11.9 mm or more in length) removed from the prostate gland for microscopic examination. During handling or processing, these delicate core tissue samples can break into pieces or fragments (no longer singular cores of tissue). The term “chip” is most often associated with a TURP procedure.

Findings from the prostate biopsies are recorded in the SSDIs Number of Cores Examined, and Number of Cores Positive. These core counts can be found in the pathology report. Typically, the pathologist will record the number of cores positive in the synoptic report (which includes the final diagnosis), while the number of cores examined is found in the gross description. More often than not, the registrar will have to count the number of cores documented to get a final count.

If any of the cores documented in the pathology report mention pieces, chips, or fragments, then the total count for the cores positive or examined would be X6 (biopsy cores examined/positive, number unknown).

Updated: June 15, 2026