Prostate cancer staging
What is a “stage” of prostate cancer?
When it concerns cancer, the word “stage” refers to the extent of the disease. Prostate
cancer staging involves both the size of the tumor and whether or not it has spread
to other parts of the body such as the lymph nodes. Staging is very important, because
it helps healthcare professionals determine the most appropriate treatment.
Prostate cancer is both staged and graded.
As part of the diagnosis process, prostate cancer is
graded and staged. The grade describes how aggressive the cancer is and
how fast it is likely to grow.
The prostate cancer Gleason score.
Most pathologists use the Gleason system to grade prostate cancer. They look for
the most common type of cancer cell in the sample and assign it a number between
1 and 5—the higher the number, the more abnormal the cells are. Another number is
assigned to the second-most common type of cancer cell in the sample. The Gleason
score is the sum of these two numbers, which will be between 2 and 10.
A higher Gleason score indicates that the cancer is likely to grow and spread quickly,
and should be treated.
These are the stages of prostate cancer and what they mean
Stage I prostate cancer.
The prostate cancer may not have been detected through a digital rectal exam (DRE)
or an imaging machine (MRI, CT scan, etc). Most likely, it was found during a surgical
procedure. It has a very low Gleason score and has not spread to the lymph nodes
Treatment.
Stage I prostate cancers are small and have low Gleason scores (2–4). Generally,
these tumors grow slowly and may never cause health problems. Watchful waiting is
a common way of managing these cancers. For men who want to start treatment, radiation
therapy, hormone deprivation, and surgery are available as options
These are the stages of prostate cancer and what they mean
Stage II prostate cancer.
The prostate cancer has not spread to the lymph nodes or other parts of the body.
It was found during a DRE, needle biopsy, or transrectal ultrasound
Treatment.
Surgery and radiation therapy are the most likely treatments. But for older men
whose cancer is not causing any symptoms, watchful waiting may be enough. Radiation
therapy may be combined with months of hormone therapy if there is a high chance
of recurrence (the cancer returning) based on a high PSA level or Gleason score
These are the stages of prostate cancer and what they mean
Stage III prostate cancer.
The prostate cancer has begun to spread beyond the prostate. It may have spread
to the seminal vesicles, but it has not spread to the lymph nodes, bladder, rectum
or distant organs
Treatment.
Likely treatments include external beam radiation and hormone therapy in combination,
hormone therapy alone, and surgery to remove the prostate and nearby lymph nodes,
which is often followed with radiation. These cancers are more likely to come back
after treatment (to recur)
These are the stages of prostate cancer and what they mean
Stage IV prostate cancer.
The prostate cancer has spread to tissues next to the prostate (other than the seminal
vesicles), to lymph nodes, or to other, more distant sites in the body such as the
bones. These cancers are not considered curable
Treatment.
Hormone therapy, radiation, and surgery to relieve symptoms are all options at this
point. If these treatments do not relieve symptoms, and the cancer continues to
spread throughout the body, chemotherapy is an option. People with stage IV cancer
may want to consider enrolling in a clinical trial to test a new therapy
What system do doctors use when staging prostate cancer?
The Staging System of the American Joint Committee on Cancer, also referred to as
the TNM system, is used most often by doctors to describe a patient's cancer.
The TNM system involves 3 scores that describe:
- The tumor type
- Whether or not lymph nodes are involved
- How far the cancer has spread
Tumor, Node, and Metastasis (TNM) staging
Primary tumor (T)
|
T0
|
There is no evidence of a tumor
|
|
T1
|
The tumor cannot be seen without using imaging techniques
|
|
T2-4
|
The higher numbers indicate the size and extent of the primary tumor
|
Nodes (N)
|
N0
|
The cancer has not spread to the
lymph nodes
|
|
N1
|
The cancer has spread to the lymph nodes
|
Metastasis (M)
|
M0
|
No distant metastasis, meaning the cancer has not spread beyond the regional lymph
nodes
|
|
M1
|
Distant metastasis, meaning the cancer has spread to other organs
|
People fighting prostate cancer who are in otherwise good health can take part in
clinical trials of other new potential treatments.
Staging is complex, so be sure to ask your doctors and nurses any questions you
have about it.
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