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How Is Prostate Cancer Stage Determined

Stage : Prostate Cancer Is Limited To A Small Part Of The Prostate

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  • Often, the cancer is found as a result of needle examination of tissue for another reason, such as benign prostatic hypertrophy , also known as an enlarged prostate, or because of an elevated result on a prostate specific antigen test, which uses PSA levels as an indicator of potential cancerous growth.
  • Cancer cells are only found in a small part of the prostate. The cells look like normal cells and the prostate feels normal with a digital rectal exam .
  • PSA is less than 10.
  • Gleason score, which assigns a grade to what the cancer cells looks like under a microscope, is less than 6, the Prostate Cancer Foundation notes.

Treatment For Prostate Cancer At Moffitt Cancer Center

When a patient turns to Moffitt Cancer Center for diagnosis or treatment, we provide them with an individualized treatment plan that a multispecialty team of experts carefully assembles based on a comprehensive range of factors. We understand that prostate cancer stages are just a small part of the big picture our oncologists evaluate everything from the stage and cellular makeup of the cancer to the patients overall health and personal preferences, and then tailor a treatment plan to fit the patients unique situation.

Medically reviewed by Monica Chatwal, MD.

No referral is required to come to Moffitt. You can request an appointment online or call , and well set up a time for you to meet with one of our oncologists specializing in prostate cancer.

Histopathologic Grade For Prostate Cancer

An additional factor influencing prognosis is histopathologic grading. Tissue obtained from a needle biopsy or a prostatectomy is graded using the Gleason Grading System. Gleason grades range from 1 to 5. Each specimen is assigned two grades based on the most common and second most common pattern. These numerical values are added to calculate the Gleason Score.

Gleason score cannot be assessed

Gleason 6

Gleason 8-10

Poorly differentiated or undifferentiated

The 8th edition of the AJCC Cancer Staging Manual took effect on January 1, 2018. A major change is that tumor grading now involves the Gleason Score, as well as the grade group.

4 + 4
5 4 + 5, 5 + 4, 5 + 5

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Hormone Therapy With Radiation

Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancer’s progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.

Learn more about hormone therapy.

First Line Treatment For Advanced Prostate Cancer

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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.

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Stage Ii Prostate Cancer

The tumor is more advanced or a higher grade than Stage I, but the tumor doesnt extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.

  • Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated.

  • Stage IIB: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated.
  • Stage IIC: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.

Stage Iv Prostate Cancer

When prostate cancer spreads, its often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, its treated as prostate cancer, not bone cancer. Doctors call the new tumor distant or metastatic disease.

The cancer has spread beyond the prostate.

  • Stage IVA: The cancer has spread to the regional lymph nodes.
  • Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.

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Screening For Prostate Cancer

At UCSF, we believe in testing men so they know if they have prostate cancer, but that doesn’t mean every man diagnosed should have aggressive treatment. Screening is the only way to detect high-risk, potentially life-threatening prostate cancer early, while it can still be cured.

Most prostate cancers in the U.S. are identified through the following screening tests:

  • Prostate-specific antigen . This simple blood test checks levels of prostate-specific antigen, a protein produced by prostate cells. The higher the PSA level, the more likely prostate cancer is present. But PSA elevations can also occur in benign conditions, most commonly benign prostatic hyperplasia, in which the prostate enlarges, as occurs in most men over their lifetime.
  • Digital rectal exam . For this physical examination, your doctor inserts a lubricated gloved finger into your rectum to feel for any irregular or abnormally firm areas. While most prostate cancers are detected by PSA screening, some cancers produce little PSA but are detected by DRE.

In some circumstances, your doctor may order a repeat PSA or other tests to help determine whether a benign condition led to an elevated PSA. These tests may include:

  • Multiparametric MRI

An MRI exam of the prostate is helpful and can allow for a more targeted biopsy.

How Prostate Cancer Staging Is Done

HDR Brachytherapy for the Teal Stage of Prostate Cancer | Prostate Cancer Staging Guide

Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.

PSA refers to a protein made by the prostate measured by a lab test.

  • A higher level of PSA can indicate a more advanced cancer.
  • The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.

A prostate biopsy is done in your doctor’s office. The results can indicate:

  • How much of the prostate is involved.
  • The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.

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Staging Prostate Cancer Grades And Stages

Overview by Professor Chris FosterProfessor of Molecular and Clinical Cancer MedicineMedical Director of Pathology HCA Healthcare UKPAGE AWAITING APPROVAL

Staging prostate cancer

Grades and Stages are used to describe what a cancer looks like under a microscope and the size and spread of the tumour.

The Cancer GradeThe Cancer Stage The TNM Staging system

  • Tumour : How large is the primary tumour ? Where is it located ?
  • Node : Has the tumour spread to the lymph nodes? If so, where, and how many ?
  • Metastasis : Has the cancer metastasized to other parts of the body? If so, where and how much?

Gleason Score For Grading Prostate Cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.

Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

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Advanced Prostate Cancer Life Expectancy And Prognosis

Typically, each stage of prostate cancer has different prognosis. In general, the advanced stages of the disease are much more difficult to treat than when the disease is still at early stage not yet spread. What are factors that affect the outlook and life expectancy of patient? The following are some statistics for each stage of this disease.

You might also like to know more about how fast prostate cancer spreads and what are the most common sites /organs of the body for the metastasis of this cancer in this section, before continuing

One thing you need to clearly understand that there is no any statistic that can be detail enough to tell you about what will happen. In other words, this statistic is only purposed for general information! In fact, each case of cancer is unique. So, there is always a chance and a hope for anyone who diagnosed with cancer.

Advanced prostate cancer symptoms

The symptoms of the disease are more likely to occur when the disease at advanced stage. This is the most challenging for doctors, because the early warning signs that are more likely to not occur will increase the number of patients diagnosed with the disease at later stages.

Once the cancerous tumor is bigger in size and also spreads to nearby sites or even other distinct organs of the body, there will be more complications that can be generated. These may include:

Understanding n-years survival statistics

The major factors that affect the outlook of patients

What Is A Gleason Score

Metastatic prostate cancer, 3D CT scan

Cancer cells donât look the same as healthy cells. The more different they appear, the more aggressive the cancer tends to be.

The Gleason system uses the numbers 1 to 5 to grade the most common and second most common patterns of cells found in a tissue sample.

  • Grade 1: The tissue looks very much like normal prostate cells.
  • Grades 2-4: Cells that score lower look closest to normal and represent a less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
  • Grade 5: Most cells look very different from normal.

Doctors add your primary and secondary numbers together to form your total Gleason score. That tells you how aggressive the cancer is. The lowest score for a cancer is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer.

Generally speaking, the higher your Gleason score, the more aggressive the cancer. That means itâs more likely to grow and spread to other parts of your body. Doctors use this information, along with the stage of the cancer, to choose the best treatment for you.

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Gleason Score Vs Grade Groups

The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.

One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:

  • 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
  • 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.

So, although both situations give a Gleason score of 7, they actually have very different prognoses.

Heres an overview of how the two grading systems compare:

Cancer grade
grade group 5 910

Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.

Stage Iv Prostate Cancer Treatment Options

Treatment for Stage IV prostate cancer focuses on controlling the cancer as long as possible and improving quality of life. Occasionally, Stage IV prostate cancer may be curable with some of the same treatments as Stage III prostate cancer.

Men who are older or have other medical problems and dont have major symptoms from the prostate cancer may choose active surveillance.

For other men, treatment options include:

  • Hormone therapy, possibly along with chemotherapy
  • External beam radiation, possibly along with brachytherapy plus hormone therapy
  • Surgery, possibly with external beam radiation therapy radiation therapy afterward
  • Surgery to relieve symptoms such as bleeding or urinary obstruction
  • Treatments for cancer thats spread to the bones, such as:
  • Drugs such as Denosumab or zoledronic acid
  • External beam radiation therapy

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What Does Staging And Grading Mean For Treatment

The prostate cancer stage and grade are important for determining your course of treatment. Some treatments are only effective for Stage I and II prostate cancer and other treatments are only necessary for Stage III and IV prostate cancer.

Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with more aggressive prostate cancer treatment options. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance or watchful waiting and avoid common side effects.

In any case, the stage and grade must be discussed with your doctor and healthcare team.

What Are The Damico Risk Categories

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The DAmico system provides an estimate of the risk of recurrence at five years after treatment. This system is one of the most widely used for risk assessment. It combines the PSA, Gleason score, and the clinical stage to create low, intermediate, and high risk categories. The higher the risk category, the higher the chance of recurrence is five years after treatment.

The DAmico risk categories are below. If one factor is putting you in a lower category but another is putting you in a higher category, then the higher category takes precedent.

Low Risk:

  • PSA is less than 10 ng/mL AND
  • Gleason score is equal to or less than 6 AND
  • Clinical stage T1-T2a
  • PSA is between 10 and 20 ng/mL OR
  • Gleason score is 7 OR
  • Clinical stage T2b
  • Gleason score is 8-10 OR
  • PSA is greater than 20 ng/mL OR
  • Clinical stage T2c-T3

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Accessing Clinical Trials At Ucsf

UCSF is currently conducting research in four main areas:

  • Identification of genetic and lifestyle factors that predispose men to clinically significant prostate cancer
  • Discovering alterations in genes and proteins to improve current prostate cancer treatment
  • Developing new therapies for men with recurrent widespread prostate cancer
  • Preventing progression of early-stage untreated disease

To learn more, search for a trial or contact us, visit Cancer Clinical Trials at UCSF.

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