What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9
Because grades 1 and 2 are not often used for biopsies, 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 that is, 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 are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.
Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:
- Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
- A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.
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The Tnm System For Prostate Cancer Stages
As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:
- Tumor. Whatâs the size of the main area of prostate cancer?
- Nodes. Has it spread to any lymph nodes? If so, how far and how many?
- Metastasis. How far has the prostate cancer spread?
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What Tests Check For Prostate Cancer
Common tests to check for prostate cancer include:
- Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
- PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
- A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.
If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
What Does Gleason 6 Mean
A Gleason score of 6 is different from other prostate cancer diagnoses because it means all the biopsy samples are grade 3 . Though the samples dont look like normal tissue, no grade 4 or 5 samples were found.
Gleason 6 prostate tumors are:
- Confined to the prostate
- Not causing any symptoms
There are changes at the cellular level, but the prostate cancer is likely slow-growing and has a low-risk of metastasizing, or spreading to other areas of the body.
This knowledge allows your doctor to monitor you and see how your tumor changes over time.
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Stages Of Prostate Cancer
Any T, any N, M1
Any Grade Group
The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.
Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.
While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.
Active Surveillance In Men With Gleason 3 + 4 = 7 Prostate Cancer At Diagnosis
A critical question for men with favorable intermediate-risk prostate cancer can often be, How safe would it be for me to go on active surveillance for a while after initial diagnosis?
So let us be very clear about one thing immediately.
A man with favorable intermediate-risk prostate cancer who starts on active surveillance is always going to have a higher probability of the need for later treatment if he starts on active surveillance that an otherwise identical man who has only Gleason 3 + 3 = 6 disease.
So the question about How safe it would be for such a man to start on active surveillance as opposed to having immediate treatment is really about how effective treatment will be later when it actually becomes necessary.
The abstract of a presentation by Kalapara et al., to be given at the upcoming annual meeting of the American Urological Association, provides us with some reassuring information that addresses this precise question.
The patients who started on active surveillance and then went on to have a radical prostatectomy were divided into two groups:
After patients had surgery, they were assessed as to whether their post-surgical pathology and clinical outcomes were either favorable or unfavorable. Unfavorable disease was defined as prostate cancer with a Gleason score of 4 + 3 = 7 or pathological stage T3 and biochemical failure .
Here is a summary of the study findings:
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Point: Should Active Surveillance Be Used For Gleason 3+4 Prostate Cancer
Sanoj Punnen, MD, MASOncology
In this Point/Counterpoint, Drs. Bhat and Punnen argue that active surveillance can be beneficial for patients with intermediate-risk prostate cancer.
While the use of active surveillance among men with low-risk prostate cancer has increased, its role in men with intermediate-risk disease remains debatable. Current American Society of Clinical Oncology /Cancer Care Ontario guidelines recommend treatment for most men with intermediate-risk disease, but state that men with low-volume Gleason 3+4 prostate cancer may be considered for active surveillance. The recent National Comprehensive Cancer Network guidelines list active surveillance as an initial therapy option for men with favorable intermediate-risk disease, which they define as clinical stage T2b-T2c, Gleason score 3+4, or prostate-specific antigen levels at 1020 ng/mL, as well as less than 50% of positive biopsy cores. While it remains an option in current guidelines and has been increasing in contemporary clinical practice, there remains significant controversy over the safety of active surveillance in intermediate-risk prostate cancer.
Financial Disclosure:The authors have no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article.
Table 2 What Guides Treatment Recommendations
Both of the situations below involve men diagnosed with a tumor that is small in size , yet who may require quite different treatments, based on their PSA level and Gleason score. Of course, many men have clinical profiles that vary from these two extremes.
Clinical profile Low PSA
Low Gleason score
80% of men with this profile probably have locally confined disease.
It is likely that fewer than 3% will have evidence of cancer in lymph nodes.
Surgery, radiation, or active surveillance . High PSA
High Gleason score
5% of men with this profile probably have locally confined disease.
More than 20% probably have evidence of cancer in the lymph nodes.
Systemic therapy rather than surgery .
Radical prostatectomy . The surgeon removes the prostate and seminal vesicles . In some cases, pelvic lymph nodes are also sampled. This is most often performed through an abdominal incision abdominal surgery may also be done with a laparoscope. A third option is the perineal technique, involving an incision in the area between the scrotum and the anus . The most common side effects are
- mild to severe incontinence .
External beam radiation therapy. After a CT scan constructs a three-dimensional picture of the prostate and seminal vesicles, the radiation oncologist directs rays of high-energy radiation at the prostate tumor and sometimes at nearby lymph nodes. The most common side effects are
- mild to severe incontinence .
- mild to severe incontinence .
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More Detail On Staging
The standardized Tumor, Node, and Metastasis system is used to stage prostate cancer. The T category is based on the extent of the tumor itself. The N category is based on whether the cancer has spread to nearby lymph nodes. The M category is based on whether the cancer has spread beyond nearby lymph nodes.
British Columbia Specific Information
Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.
You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.
Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency Prostate.
Top of the pageDecision Point
You may want to have a say in this decision, or you may simply want to follow your doctors recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
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Tools To Help You Decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasn’t spread.
It can’t tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.
To be able to use the tool you need to know the following about your cancer:
- PSA level
What Are The Damico Risk Categories
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.
Psa Measurable By Standard Blood Test
Producing seminal fluid, the prostate also generates a molecule known as Prostate-Specific Antigen, or PSA. It is a prostate specific substance that circulates in the prostate and blood . PSA is a tumor marker used at all stages of prostate cancer treatment: screening, diagnosis, post-treatment follow-up, diagnosis after recurrence.
PSA tests are often recommended from about age 50. Dosageis done with a standard blood test for which it is not necessary to be fasting.8 days must separate PSA dosage from a rectal examination and 2 months in caseof a recent rectal examination. However, PSA is not specific to prostate cancerbecause it also increases with other prostate pathologies: Benign ProstaticHyperplasia, inflammation and infection of the prostate. One of the first stepsof prostate cancer diagnosis, PSA test must be completed by other diagnostics:5 to 10% of cancers that can be felt during a rectal examination have a normalPSA at the start.
- Thresholdvalue used for prostate cancer screening is 4 ng/mL: from 4 to 10 ng/mL, 70% ofdiagnosed cancers are localized.
- APSA higher than 30 ng/mL reflects an advanced localized prostate cancer with a highprobability of locoregional lymph node metastases.
- APSA higher than 100 ng/mL reflects anadvanced localized prostate cancer, with a high bone metastases probability.
What Is A Grade Group
In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.
The Grade Group system is simpler, with just five grades, 1 through 5.
*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.
Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.
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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.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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The Sum Of Two Numbers
The pathologist assigns two separate grades to the two predominant cancer cell patterns in the prostate tissue sample. They determine the first number by observing the area where the prostate cancer cells are most prominent. The second number, or secondary grade, relates to the area where the cells are almost as prominent.
These two numbers added together produce the total Gleason score, which is a number between 2 and 10. A higher score means the cancer is more likely to spread.
When you discuss your Gleason score with your doctor, ask about both the primary and secondary grade numbers. A Gleason score of 7 can be derived from differing primary and secondary grades, for example 3 and 4, or 4 and 3. This can be significant because a primary grade of 3 indicates that the predominant cancer area is less aggressive than the secondary area. The reverse is true if the score results from a primary grade of 4 and secondary grade of 3.
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Understanding Prostate Cancer: The Gleason Scale
Knowing the numbers
If you or a loved one has been diagnosed with prostate cancer, you may already be familiar with the Gleason scale. It was developed by physician Donald Gleason in the 1960s. It provides a score that helps predict the aggressiveness of prostate cancer.
A pathologist begins by examining tissue samples from a prostate biopsy under a microscope. To determine the Gleason score, the pathologist compares the cancer tissue pattern with normal tissue.
According to the
Mri With A Tesla 30 Magnet Age Of Friend
Speak with the urologist about prescribing a Tesla 3.0 MRI . This test is very effective in indicating if there is any nodule involvement, if there is involvement in one or two lobes, will show size of prostate, any evidence of extracapular extension, will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet. In my laymans opinion it is advisable to have such a test before any surgery or another active treatment which is a localized one. If the cancer is outside the prostate these type treatments may not be a best decision for treatment since additionally treatment will still be required, and side effects of various treatments are cummulative.
The side effects of surgeries are basically greater than other active treatment types. Surgery is less successful among older men than younger so for example a doctor may perform an excellent surgery for a 50 year old, who will have no side effects and the exact same surgery for a 70 year old who will have side effects.
How old is your friend?
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