What Stages Have To Do With Cancer Spread
Cancers are staged according to tumor size and how far it has spread at the time of diagnosis. Stages help doctors decide which treatments are most likely to work and give a general outlook.
There are different types of staging systems and some are specific to certain types of cancer. The following are the basic stages of cancer:
- In situ. Precancerous cells have been found, but they havent spread to surrounding tissue.
- Localized. Cancerous cells havent spread beyond where they started.
- Regional. Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant. Cancer has reached distant organs or tissues.
- Unknown. Theres not enough information to determine the stage.
- Stage 0 or CIS. Abnormal cells have been found but have not spread into surrounding tissue. This is also called precancer.
- Stages 1, 2, and 3. The diagnosis of cancer is confirmed. The numbers represent how large the primary tumor has grown and how far the cancer has spread.
- Stage 4. Cancer has metastasized to distant parts of the body.
Your pathology report may use the TNM staging system, which provides more detailed information as follows:
T: Size of primary tumor
- TX: primary tumor cant be measured
- T0: primary tumor cant be located
- T1, T2, T3, T4: describes the size of the primary tumor and how far it may have grown into surrounding tissue
N: Number of regional lymph nodes affected by cancer
M: Whether cancer has metastasized or not
Questions To Ask Your Doctor Or Nurse
- What type of hormone therapy are you offering me and why?
- Are there other treatments I can have?
- What are the advantages and disadvantages of my treatment?
- What treatments and support are available to help manage side effects?
- Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
- How often will I have check-ups and what will this involve?
- How will we know if my cancer starts to grow again?
- What other treatments are available if that happens?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
Who Should Have Focal Therapy
Candidates for focal therapy must be carefully selected, most often based on well-performed, image-guided biopsy techniques . Patients with intermediate-grade tumors visible in a single location on imaging may be considered for focal therapy. Low-grade cancers can be treated this way but are usually more suitable for active surveillance. Some doctors feel that cancer close to the urethra can also be treated in this fashion, but there may be a higher risk of side effects or incomplete treatment. Some feel that additional candidates for focal therapy include patients with one dominant tumor as described above and a microfocus of low-grade disease elsewhere. These smaller cancer foci are followed through active surveillance.
Results of ablation therapies to date have been favorable, but the experience and time of follow-up are still limited. In addition, these patients must be evaluated carefully to avoid undertreating their cancer, and after treatment, they need to have periodic imaging, PSA assessment and at least one follow-up biopsy.
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What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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As Screening Falls Will More Men Die From Prostate Cancer
In active monitoring, men with localized prostate cancer do not get surgery or radiation right after theyre diagnosed. Instead, they have regular biopsies, blood tests, and MRIs to see if their cancer is progressing. If it is, they can receive treatment.
Although some oncologists advise men with early, low-grade prostate cancer to choose active surveillance and professional groups such as the American Society of Clinical Oncology recommend it many patients recoil at what sounds like lets just wait for your cancer to become really advanced. A decade ago fewer than 10 percent of men diagnosed with prostate cancer chose monitoring, UCLA researchers found. But that is changing. Now at least half of men do.
That made sense to Garth Callaghan, author of the best-selling Napkin Notes, a book of missives he tucked into his daughters lunch box. Diagnosed with early prostate cancer in 2012, he said, none of the choices seemed particularly attractive to a 43-year-old man who dreaded the possibility of side effects of surgery or radiation, including incontinence and impotence. I was completely torn. My previous experience was, just get it out of my body. But after his doctor explained that prostate cancer is grossly overtreated in the United States, I did a complete 180 and chose active monitoring.
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What Is Advanced Or Metastatic Prostate Cancer
Prostate cancer is the abnormal growth of cells in the prostate gland . The prostate is part of the male reproductive system. Locally advanced prostate cancer means that the cancer has spread beyond the prostate and into nearby tissue. Metastatic prostate cancer means that the cancer has spread, or metastasized, to the lymph nodes or other parts of the body.
Recurrent prostate cancer means that the cancer has come back after it was treated. The cancer can come back in the prostate. Or it can come back near the prostate or in another part of the body. If it comes back in another part of the bodyoften the bonesit is still called prostate cancer because it started in the prostate.
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In the Community
2019 Gentlemen Stakes for Prostate Cancer
Since 2006 we have held annual fundraisers for prostate cancer awareness and research programs. Whether itâs a 5k/10k event or a celebration for our cancer survivors, we believe in giving back. These events benefit ZERO â the End of Prostate Cancer. A number of local and national businesses also sponsor the event.
The risk of being diagnosed with advanced-stage prostate cancer is less than one in 10. Yet thats no reason to doubt the realities of such a prognosis.
Just 7% of men have advanced-stage prostate cancer at the time of diagnosis. For these men, this highly treatable disease becomes a far more serious issue.
Once the cancer has spread beyond the prostate, only about 30% of men survive for more than five years. That compares with a near-100% survival rate when the cancer is detected early. And almost all cases of prostate cancer are detected early , thanks to preventive screening.
But unfortunately, some men are at a higher likelihood of being diagnosed with late-stage prostate cancer, even if they start getting screenings at the recommended age of 50.
This is What Late-Stage Prostate Cancer Means
The prostate is a small gland located below the bladder and in front of the rectum. Prostate cancer occurs when abnormal cells in the gland begin to divide uncontrollably, forming an invasive tumor.
Who Is at Greater Risk of Late-Stage Prostate Cancer?
Look for These Symptoms
Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
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What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
Soreness In The Groin
When prostate cancer spreads, its common for cancer cells to go to your lymph nodes and then move to more areas of your body. The lymph nodes are a network of glands that help your body filter fluids and fight infections.
There are several lymph nodes in your groin. These are the ones closest to your prostate, so its common for the cancer to spread to them first. Cancer cells prevent your lymph nodes from draining fluid and working properly. When this happens, your lymph nodes swell. As a result, you might experience pain or soreness in the area.
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How Fast Does Prostate Cancer Spread To The Bones
Early detection can catch prostate cancer even before there are any symptoms. Some types of prostate cancer grow very slowly.
There are four main stages of prostate cancer. Within each stage, the cancer is graded based on factors like the size of tumor, prostate-specific antigen level, and other clinical signs.
If the cancer has spread to the bones, its considered to be the most advanced, or stage 4.
Newer lab tests look at the genes inside cancer cells. This can provide more information on how quickly the prostate cancer may progress.
Theres also a grading system known as the Gleason system, which assigns the cancer into a grade group based on how closely it resembles normal tissue.
During the biopsy to diagnose prostate cancer, the cells are closely examined. The more abnormal cells that are in the biopsy sample, the higher the Gleason score and grade group.
When more abnormal cells are present, the cancer is more likely to spread quickly.
External Beam Radiation Therapy
With EBRT, radiation usually in the form of X-ray photons is focused from a source outside the body onto the prostate and, if needed, surrounding lymph node areas. In preparation for the therapy, internal markers are implanted in the prostate, using a procedure similar to prostate biopsy they’re used to help align and target the prostate with the radiation beam. A planning CT scan is then performed to locate the prostate gland in relation to the surrounding structures and organs. The resulting images are used to make a treatment plan that targets the prostate gland while protecting healthy surrounding tissues .
Most radiation today is given as a type of EBRT known as intensity-modulated radiation therapy , in which the shape and intensity of several fine radiation beams can be varied during treatment to minimize damage to surrounding tissues. At UCSF, patients also benefit from image-guided radiation therapy , where the prostate is imaged immediately before the start of each treatment session to verify and adjust the position of the gland for added accuracy. Stereotactic body radiation therapy, or SBRT , is a special type of IMRT/IGRT in which high doses of radiation are given over a small number of treatments .
The schedule for EBRT treatments varies. Treatment may be delivered in one of the following ways:
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Prostate cancer has the potential to grow and spread very quickly. It is important for patients to discuss their various testing options with HSP Group. The number of men being diagnosed with cancer is rising year on year. Men need to be pro-active and educated to recognise the warning signs of prostate cancer and other male cancers. Early detection can save your life. We encourage regular self-examinations and cancer screenings as symptoms dont always present until the cancer has spread.
What is a Prostate?
The prostate is a walnut sized gland that is part of the male reproductive system and located beneath the bladder in front of the rectum.
Why do men have a prostate?
How does the prostate grow and remain active?
The activity and growth of the prostate is stimulated by the male hormones called Androgens.
Risk Factors
Although the exact cause of prostate cancer is unknown, there are certain aspects of life that may increase your chance of having prostate cancer.
These include:
Having a risk factor does not mean that you will get Prostate cancer. Most men with any of the above risk factors never develop this disease.
How do I test for Prostate Cancer?
PSA testing can be done by means of a basic finger prick test and if a positive result is found, a PSA blood test will then be recommended to determine the actual level of the PSA.
- An enlarged prostate
Psa Levels In Metastatic Prostate Cancer
As part of your ongoing treatment, your care team will regularly test your PSA levels. PSA stands for prostate-specific antigen, which can be high in men who have prostate cancer. PSA tests are used not only for the initial cancer diagnosis but also to observe the advancement of the disease over time.
Generally, PSA levels are higher in men with metastatic prostate cancer. However, in rare cases, its possible to have a low PSA even if you have metastatic disease. For these patients, disease progression is better measured in other ways, such as through imaging tests and biomarker tools.
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.