404 Coded
Internet slang borrowed from the web's "404 — Page Not Found" error, the message you get when the thing you're looking for isn't there. Being "404 coded" means being absent, offline, unreachable — nothing loading. As used here: my summer of radio silence. Friends checked for updates and got nothing — updates not found. Not because nothing was happening, but because I'd gone quiet on purpose while the slides made their rounds.
Active surveillance
Watching the cancer with regular blood tests, scans, and sometimes repeat biopsies, but not treating it. Used when the cancer is low-grade enough that treatment side effects would do more harm than the cancer is doing on its own.
Adenocarcinoma
Cancer of gland-forming cells. About 95% of prostate cancers are adenocarcinomas, so when someone says "prostate cancer" without qualifying it, this is almost always the type they mean.
Adjuvant therapy
Additional treatment added immediately after a primary treatment to reduce the risk of recurrence — given because features in the primary result (positive margins, EPE, seminal vesicle involvement, lymph node involvement) suggest higher residual risk. Different from salvage therapy, which is given only after the cancer has actually come back.
Aura Farming
Slang the kids use for deliberately collecting "aura" — doing conspicuously impressive things to build an air of effortless credibility. You don't just do the cool thing; you're seen doing it. As used here: when your biopsy needs a second opinion and you send the slides to the man who invented the grading system the entire field uses, that's not just due diligence — that's maximum-credibility pathology. You cannot out-aura a re-read by the guy who wrote the rules.
Biochemical recurrence BCR
Rising PSA after treatment, signaling the cancer is reasserting itself somewhere — without (yet) any visible tumor on scans. Defined differently after each treatment: after surgery, PSA rising to 0.2 ng/mL or above on two consecutive readings; after radiation, PSA rising 2 ng/mL above the post-treatment nadir.
Biopsy
A procedure where small tissue samples are taken from the body so they can be examined under a microscope. For prostate biopsy, samples are taken with a thin needle.
Biopsy core
A single thin cylinder of tissue removed by the biopsy needle. Each core gets examined separately under the microscope, which is why the count matters: more cores, more chances to find or rule out cancer.
Clearance physical
A short medical exam by your primary care doctor confirming you're healthy enough to undergo a procedure that involves sedation. Usually requires a form sent over by the procedure office that has to be filled out and returned before the procedure is officially booked.
Cribriform pattern
Cancer cells arranged in a sieve-like shape with multiple small holes when viewed under the microscope. An adverse pathology feature: cancers showing this pattern tend to behave more aggressively than the Grade Group number alone would predict, and most guidelines treat its presence as a reason to choose active treatment over surveillance.
DCE Dynamic Contrast Enhancement
The part of an MRI that uses an injected dye to show how blood flows through tissue. Cancer often has different blood flow patterns than healthy tissue.
DWI Diffusion-Weighted Imaging
The part of an MRI that measures how easily water moves inside cells. In cancer, cells are densely packed and water can't move freely, so cancer shows up bright on DWI.
EPE Extra-Prostatic Extension
Cancer that has grown through the prostate's outer wall (the capsule) and into the tissue just outside it. More on why this matters ›
Focal therapy
Treatment that targets only the part of the prostate with known cancer (using heat, cold, or other energy) while leaving the rest of the gland intact, aiming for fewer side effects than whole-gland surgery or radiation. It depends on the cancer sitting in one spot the scans can see clearly — larger, multi-focal, or adverse-feature disease usually takes it off the table.
Genomic testing Decipher / Artera-AI
Commercial lab tests that read the biology of the tumor tissue itself to refine the risk picture beyond what Gleason and Grade Group can tell you — useful when the right treatment isn't obvious from the biopsy report alone. Decipher analyzes 22 genes in biopsy or surgical tissue to produce a risk score from 0.00 to 1.00: a high score (above ~0.60) can push toward more aggressive treatment (longer ADT, combination radiation, or surgery with a lower threshold for adjuvant therapy), while a low score (below ~0.45) supports less intense treatment. The Artera-AI prostate test reaches a similar goal differently — using AI to read the biopsy slide images rather than gene activity.
Gleason pattern
The individual building blocks a pathologist sees under the microscope, scored 3, 4, or 5 (lower numbers existed historically but aren't used anymore). Pattern 3 is the least disordered and least aggressive; Pattern 5 is the most disordered. A Gleason score is the sum of the two most common patterns in the sample.
Gleason score
A scale from 6 to 10 that pathologists assign to prostate cancer cells based on how abnormal they look under a microscope. It's the sum of the two most common Gleason patterns in the tissue (so 3+4=7 means mostly Pattern 3 with some Pattern 4 mixed in). 6 is the lowest grade, 10 is the most aggressive. Modern reporting also translates the score into a Grade Group.
Grade Group
The modern 1-to-5 simplification of the Gleason score. GG1 = Gleason 6, GG2 = 3+4=7, GG3 = 4+3=7, GG4 = Gleason 8, GG5 = Gleason 9 or 10. The number that most directly tracks how aggressive the cancer is likely to be.
Hormone therapy ADT / Androgen Deprivation Therapy
Treatment that lowers testosterone to near-zero, starving prostate cancer cells of their primary fuel and making the remaining cells more vulnerable to radiation. Often added to radiation in unfavorable intermediate, high, and very-high-risk localized disease, with course length scaling to risk (typically 4–6 months at unfavorable intermediate; 18–36 months at high risk). Side effects include hot flashes, fatigue, loss of libido, erectile dysfunction, muscle and bone-density loss, and metabolic and mood changes — most reverse within a year of stopping, but recovery is slower with longer courses and at older ages.
Intraductal carcinoma IDC-P
Cancer cells found filling the prostate's pre-existing ducts (the small channels inside the gland), as opposed to spreading through the surrounding tissue. An adverse pathology feature: when a biopsy shows IDC-P, the cancer tends to behave more aggressively than the grade alone suggests, and most guidelines treat its presence as a reason to choose active treatment over surveillance.
Lesion
A medical word for an abnormal area of tissue. In imaging, it usually means a spot on the scan that looks different from the surrounding tissue.
MRI Magnetic Resonance Imaging
A scan that uses magnets and radio waves (no radiation) to produce detailed pictures of the inside of the body.
MRI-fusion targeted biopsy
A biopsy technique where the MRI image is overlaid on a live ultrasound during the procedure. This lets the doctor guide the needle precisely to the suspicious area instead of sampling at random spots.
NCCN risk groups
The National Comprehensive Cancer Network's standardized risk categories for newly diagnosed localized prostate cancer: very low, low, favorable intermediate, unfavorable intermediate, high, and very high. The category combines PSA, Gleason/Grade Group, tumor stage, and adverse pathology features — and it's the single biggest input into which treatments are on the table.
Neurovascular bundle NVB
One of two cords of nerves and small blood vessels that run along either side of the prostate; they control erectile function. Because they sit right against the gland, they're the crux of the side-effect conversation. In surgery the surgeon tries to peel them off and spare them, but may have to sacrifice one for a clean margin where the tumor hugs the capsule; radiation can't avoid dosing them. How much of these bundles survives is the biggest driver of erectile recovery, either way.
PI-RADS Prostate Imaging-Reporting and Data System
A 1-to-5 scale radiologists use to score how suspicious an area on a prostate MRI looks. 1 is essentially nothing to worry about. 5 is very likely cancer.
Prostate
A walnut-sized gland that sits below the bladder in men. It produces some of the fluid in semen.
PSA Prostate-Specific Antigen
A protein the prostate produces, measured by a blood test. PSA can rise for many reasons, including age, infection, an enlarged prostate, and cancer. A high number isn't a diagnosis on its own. It's a flag.
PSMA PET scan Prostate-Specific Membrane Antigen Positron Emission Tomography
A specialized whole-body scan that uses a radioactive tracer that binds to PSMA, a protein found in high amounts on prostate cancer cells. It can light up cancer that's escaped the prostate in amounts too small for traditional imaging to catch — often used before a treatment decision to confirm the disease is still localized.
Radiation radiotherapy
One of the two main treatment paths for localized prostate cancer (the other is surgery). High-energy X-rays or particles are aimed at the prostate to kill cancer cells. Delivered either from outside the body in a series of sessions over several weeks (external beam radiation, sometimes compressed into a handful of sessions with SBRT), or by implanting radioactive seeds directly into the gland (brachytherapy). For localized cancer at this stage, long-term outcomes are broadly equivalent to surgery — the differences are in side effects, recovery time, and lifestyle.
Robotic prostatectomy
Surgical removal of the prostate, performed with a robot-assisted system (typically the da Vinci platform). The surgeon operates instruments through a few small abdominal incisions while seated at a console that translates hand movements into precise micro-movements inside the body. Compared to open surgery, it usually means less blood loss, smaller scars, and a faster recovery. Often recommended for younger or otherwise healthy patients when surgery is the chosen treatment for prostate cancer.
Salvage therapy
Treatment given after a primary treatment fails — meaning the cancer has come back (often signaled by biochemical recurrence). After surgery, salvage radiation (often with ADT) is the standard response. After radiation, options narrow: salvage prostatectomy is technically possible but harder, with worse continence and erectile outcomes; salvage cryotherapy or HIFU are options at some centers; ADT becomes a frequent fallback. The asymmetry — surgery preserves radiation as a salvage tool, radiation largely closes the surgical door — is one of the real differences between the two primary paths.
Sedation propofol
The medication used to put you in a deep, comfortable sleep during a procedure. Different from full general anesthesia. You wake up quickly when it stops.
Seminal vesicle
One of two small glands that sit just behind the prostate and add fluid to semen. They matter for staging: cancer reaching them raises the stage, so reports specifically note whether they look involved or clean.
SpaceOAR
A small hydrogel spacer injected between the prostate and the rectum before radiation. It pushes the rectum a few millimeters away from the radiation field, materially reducing the dose to rectal tissue and lowering the rate of bowel side effects. Placed in a brief outpatient procedure under local or light sedation. Dissolves naturally over several months. Standard or near-standard at most modern radiation centers.
Specimen container
A labeled jar that holds one or more biopsy cores from a specific anatomical location in the prostate. The pathologist examines each container's contents separately and reports findings by location — which is how a biopsy report can say "cancer in the right mid-gland but nothing on the left."
Transperineal biopsy
A biopsy where the needle enters through the skin between the scrotum and rectum (the perineum), avoiding the rectum entirely. Lower infection risk than the older through-the-rectum approach.
Transrectal biopsy
The older biopsy method, where the needle passes through the wall of the rectum to reach the prostate. Higher infection risk because the needle crosses gut bacteria on its way in.
Tumor board multidisciplinary review
A meeting where multiple specialists — urologist, radiation oncologist, medical oncologist, pathologist, radiologist — review a case together and agree on a treatment recommendation. Standard at major cancer centers. Especially useful when the case has nuance that benefits from more than one specialty's input: adverse pathology features, equivocal imaging, or a decision where the right treatment isn't obvious from any single specialty's view.
Urologist
A doctor who specializes in the urinary tract and the male reproductive system, including the prostate.
Deeper Dives
Botsplainations
Longer-form explanations of terms that need more context than a glossary line can carry.
EPE Extra-Prostatic Extension
Cancer that has grown through the prostate's outer wall (the capsule) and into the tissue just outside it.
Why it matters
The prostate has a thin fibrous outer layer — the capsule — that acts as a natural barrier. As long as cancer stays inside it, the disease is "organ-confined" and easier to treat with a clean margin (whether by removing the prostate or radiating it). Once cancer breaks through the capsule, two things change:
- Surgical margins get harder. The surgeon has to take more surrounding tissue to get all the cancer out — which can mean sacrificing the neurovascular bundle (the nerve bundle controlling erections) on the affected side.
- Staging goes up. Organ-confined disease is staged T2. EPE bumps it to T3a. This affects risk classification and may push toward adding radiation, ADT, or both alongside surgery.
Why the question came up for you
Your April 2026 MRI said "No definite [EPE] but broad abutment on capsule" at the right mid PZPL lesion. Translation at that point: the radiologist couldn't see cancer clearly outside the prostate, but the lesion was sitting against the capsule along a wide area — which is a setup for microscopic EPE that imaging can miss.
Now that biopsy has confirmed cancer at that exact site (plus right lateral, which is also near the capsule), the EPE question gets re-asked with sharper stakes: given confirmed cancer broadly touching the capsule, what's the realistic probability of microscopic EPE that we won't know about until after surgery?
Standard tools used to estimate that probability pre-treatment:
- Partin tables — a long-standing nomogram (lookup table converting PSA, Gleason, and clinical stage into probabilities of organ-confined disease, EPE, seminal vesicle invasion, and lymph node involvement).
- MSK / Briganti nomograms — newer online calculators doing the same thing with more inputs.
- PSMA PET/CT — can sometimes detect EPE imaging missed, though small-volume EPE is still below the resolution threshold. (Done June 13 — no spread beyond the prostate; the microscopic-EPE question stays below its resolution.)