Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We donât have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
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What Are The Stages Of Prostate Cancer
Cancer staging is first described using what is called a TNM system. The T refers to a description of the size or extent of the primary, or original, tumor. N describes the presence or absence of, and extent of spread of the cancer to lymph nodes that may be nearby or further from the original tumor. M describes the presence or absence of metastases usually distant areas elsewhere in the body other than regional lymph nodes to which the cancer has spread. Cancers with specific TNM characteristics are then grouped into stages, and the stages are then assigned Roman numerals with the numerals used in increasing order as the extent of the cancer being staged increases or the cancer prognosis worsens. Prognosis is finally reflected by considering the patients PSA score at presentation as well as their Gleason score in assigning a final stage designation.
The American Joint Commission on Cancer system for prostate cancer staging is as follows:
Traditionally, advanced prostate cancer was defined as disease that had widely metastasized beyond the prostate, the surrounding tissue, and the pelvic lymph nodes and was incurable. However, a more contemporary definition includes patients with lower grade disease with an increased risk of progression and/or death from prostate cancer in addition to those with widely metastatic disease.
The National Cancer Institute and the National Comprehensive Cancer Network guidelines on prostate cancer version 2.2017 indicate the following:
What Does It Mean To Have A Gleason Score Of 6 Or 7 Or 8
The lowest Gleason Score of a cancer found on a prostate biopsy is 6. These cancers may be called well-differentiated or low-grade and are likely to be less aggressive they tend to grow and spread slowly.
Cancers with Gleason Scores of 8 to 10 may be called poorly differentiated or high grade. These cancers tend to be aggressive, meaning they are likely to grow and spread more quickly.
Cancers with a Gleason Score of 7 may be called moderately differentiated or intermediate grade. The rate at which they grow and spread tends to be in between the other 2.
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Changing Role Of Caregivers
Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.
However, as treatment is completed, the caregiver’s role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
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How Do Doctors Find Out Your Grade Group
The pathologist grades each sample of prostate cancer cells from 3 to 5 based on how quickly they are likely to grow or how aggressive the cells look. You may hear this score being called the Gleason grade.
Doctors then work out an overall Gleason score by adding together the 2 most common Gleason grades. So for example, if the most common Gleason grade is 3, and the second most common is 4, then the overall Gleason score is 7. Or they might write the scores separately as 3 + 4 = 7. This combined score is now called the Grade Group.
There are 5 Grade Groups. Grade Group 1 is the least aggressive and Grade Group 5 is the most aggressive.
This is how the Gleason score and Grade Groups match up and what it means:
| Gleason score |
|---|
What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia
All of these are terms for things the pathologist might see under the microscope that are benign , but that sometimes can look like cancer.
Atrophy is a term used to describe shrinkage of prostate tissue . When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy. Focal atrophy can sometimes look like prostate cancer under the microscope.
Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy.
Finding any of these is not important if prostate cancer is also present.
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Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with prostate cancer include the following:
Cryosurgery
Cryosurgery, or cryotherapy, is under evaluation for the treatment of localized prostate cancer. It is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes, followed by thawing. There is limited evidence regarding its efficacy and safety compared with standard prostatectomy and radiation therapy, and the technique is evolving in an attempt to reduce local toxicity and normal tissue damage. The quality of evidence on efficacy is low, currently limited to case series of relatively small size, short follow-up, and surrogate outcomes of efficacy.
Serious toxic effects associated with cryosurgery include bladder outlet injury, urinary incontinence, sexual impotence, and rectal injury. Impotence is common, ranging from about 47% to 100%.
The frequency of other side effects and the probability of cancer control at 5 years follow-up have varied among reporting centers, and series are small compared with surgery and radiation therapy. Other major complications include urethral sloughing, urinary fistula or stricture, and bladder neck obstruction.
Proton-beam therapy
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer.
Neoadjuvant hormonal therapy
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High Acat1 Expression In Prostate Cancer Cells Correlates With The Tumor Gleason Score
Through the GEPIA database, we found that ACAT1 is an oncogene in prostate cancer . Therefore, we conducted a series of experiments to elucidate the prostate cancer-promoting role of ACAT1.
Fig. 1
High expression of ACAT1 in prostate cancer cells correlates with the tumor Gleason score. A and B. From the GEPIA database, the results show that in prostate adenocarcinoma , the expression of ACAT1 is significantly higher than that in the adjacent normal tissues . C. Expression of ACAT1 in prostate tissue sections. Normal prostate gland. Prostate cancer tissue with a Gleason score of 3. Prostate cancer tissue with a Gleason score of 4. Prostate cancer tissue with a Gleason score of 5. D. From the Human Protein Atlas, display of ACAT1 expression in prostate cancer cell lines. E. From the GEPIA database, the results show that in prostate cancer, high expression of ACAT1 is associated with a poor prognosis. F. Tumorigenic ability of PC3 cell line with stable and high expression of ACAT1 in nude mice compared with that in the negative control group
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How Prostate Cancer Spreads And Progresses
Prostate cancer grows within the prostate gland, often for many years. Over time, the cancer spreads outside the prostate. This happens in one of three ways:
- It grows into nearby tissues
- It spreads through your system of lymph nodes and lymph vessels
- It travels to distant tissues through your blood
Prostate cancer stages describe how far the cancer has spread.
Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.
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The Importance Of The Gleason Score
It’s important to understand the Gleason score because studies indicate that it correlates closely with the behavior of the cancer cells in your body. The score itself can give your doctor an idea of whether or not the cancer will be slow-growing or more aggressive.
While the Gleason score can tell your oncologist a lot about the behavior of your cancer and what type of treatment plans may be best, it is not the only method used to understand your cancer. Other factors about your cancer can also help paint the entire picture. Other points to consider include:
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PSA blood test score
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Whether cancer was found on both sides of the prostate
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Whether cancer has spread outside the prostate
Your oncologist can provide more information about what these particular points mean for your cancer diagnosis and treatment plan.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
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What If My Biopsy Shows Cancer
If the biopsy shows prostate cancer, your doctor will determine how likely your cancer is to grow quickly and spread. Sometimes, prostate cancer grows slowly over many years. But other times, it grows quickly.
Your doctor can use your PSA level, Gleason score, and tumor score to determine your risk level. The following pages give more information about Gleason score, T-score, and prostate cancer risk levels.
Gleason Score
The Gleason score is a common scale used to determine how fast your prostate cancer is likely to grow. Gleason scores can range from 2 to 10, but most often range from 6 to 10. The higher the Gleason score, the more likely your cancer is to grow and spread.
Tumor Score
The T-score tells how far your prostate cancer has grown.
- T1: The cancer is too small to be felt during a digital rectal exam or seen in an imaging test . The cancer is found from a biopsy done after a man has a high PSA level or has surgery for problems urinating. The cancer is only in the prostate gland.
- T2: The cancer can be felt during a digital rectal exam and may be seen in an imaging test. The cancer is still only in the prostate gland.
- T2a: The cancer is in one-fourth of the prostate gland .
- T2b: The cancer is in more than one-fourth of the prostate gland , but has not grown into the other side of the prostate gland.
- T2c: The cancer has grown into both sides of the prostate gland.
Risk Level
| Risk Level* |
|---|
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What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion
Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion doesnt mean that the cancer has spread, and other factors, such as the Gleason score and amount of cancer in the cores, are more important. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.
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How Important Is The Gleason Score
The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:
- The blood PSA level
- How much of each core is made up of cancer
- The number of cores that contain cancer
- Whether cancer was found in both sides of the prostate
- Whether the cancer has spread outside the prostate
Genetic And Genomic Tests For Localized Prostate Cancer
Genetic testing
A manâs inherited genes predict his prostate cancer risk. For a long time, we have known that there is a family risk in prostate cancer. If your father or brother has prostate cancer, or your mother or sister has breast or ovarian cancer, you are at higher risk of being diagnosed with prostate cancer. To partially quantify that genetic risk, a germline test can be performed before a biopsy. This test of DNA from healthy cells can determine whether you have inherited genetic mutations, such as BRCA1 and BRCA2, known to increase prostate cancer risk. If the test shows youâre low risk, you may be able to avoid a biopsy even if you have a slightly elevated PSA, while still being actively monitored for prostate cancer.
Genomic testing
If already diagnosed with prostate cancer, you may undergo another type of test for assessing your genetic risk. A genomic test of tissue from your biopsy or prostatectomy can look for somatic mutations, alterations in the DNA of the cancer cells themselves. Genomic tests measure expression of various genes that relate to how aggressive a cancer is likely to be. They indicate how rapidly cancer cells are growing and how genetically abnormal they are relative to normal cells.
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What Are The Treatments For Localized Prostate Cancer
- Surgery takes out the prostate and any nearby tissue that may contain cancer, including lymph nodes. This surgery is called a radical prostatectomy . A doctor can do it as open surgery by making a cut, or incision, in your belly or groin. Or he or she can do laparoscopic surgery by putting a lighted tube, or scope, and other surgical tools through much smaller cuts in your belly or groin. The doctor is able to see your prostate and other organs with the scope. In some places, robot-assisted laparoscopic prostatectomy may be done. In this type of surgery, the surgeon controls the robotic arms that hold the tools and scope.
- Radiation uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
- External-beam radiation, in which a machine aims high-energy rays at the cancer.
- Brachytherapy , in which tiny pellets of radioactive material are injected into or near the cancer.
- Both kinds of radiation.
Radiation and surgery are treatments that destroy or remove localized prostate cancer. Both treatments also have long-term side effects, like bladder, bowel, and erection problems.
In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.footnote 3
Follow-up treatment
What Do The Different Gleason Scores Mean
The Gleason Score is based on the aggressiveness of the prostate cancer. The lower the number, the closer to normal the cell tissue, and slower-growing the cancer is likely to be. Anything less than 6 is not considered cancer.
The Gleason Score is based on the aggressiveness of the prostate cancer.
The higher the number, the more aggressive the cancer and the more likely it is to spread. Let’s take a look at what the different scores mean:
- Low Grade: Gleason Score = 6: This indicates that more than likely the cancer will be slow-growing and not very aggressive. Patients with these scores have the best prognosis.
- Intermediate Grade: Gleason Score = 7: A score of 7 means that the patient has a 50/50 chance of having aggressive prostate cancer. If the patient received a primary grade of 3 and a secondary grade of 4, more than likely the cancer will grow slowly. However, if those numbers are reversed and the primary grade was 4 and the secondary 3, the cancer may be aggressive.
- High Grade: Gleason Score = 8-10: A score of 8-10 means the cancer is aggressive and likely to grow and spread at a rapid pace.
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