Initial Treatment Of Prostate Cancer By Stage And Risk Group
The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.
For prostate cancers that haven’t spread , doctors also use risk groups to help determine if more tests should be done and to help guide treatment options. Risk groups range from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups.
Other factors, such as your age, overall health, life expectancy, and personal preferences are also taken into account when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.
You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here.Taking part in a clinical trial of newer treatments is also an option for many men with prostate cancer.
Stage Ii Of Prostate Cancer:
In this stage, the cancer has spread within the prostate involving one or both the lobes of the prostate. These cancers do not spread beyond the prostate to nearby lymph nodes or other organs. Stage II of prostate cancer is broadly categorized into three further stages:
Here, the cancer has spread upto one complete lobe of the prostate. The Gleason score of these cancer is 6 or less than 6 and PSA levels are between 10 and 20.
When the cancer is found during biopsies, and not through general diagnostic tests, it is staged as cT1, N0, M0 Grade Group 1.
When the cancer can be found to be confined to one half of a lobe of the prostate, through screening or physical examinations and has not metastasized, it is staged as cT2a or pT2, N0, M0, Grade Group 1.
If the cancer is contained in more than half of one lobe of the prostate, but has not spread, it is staged as cT2a or pT2, N0, M0, Grade Group 1.
In this stage, the cancer has not spread beyond the prostate, but is contained in more than one lobe of the prostate, with a Gleason score of 7 and PSA levels up to 20. It is staged as T1 or T2, N0, M0, Grade Group 2.
This stage of stage II cancer is staged as T1 or T2, N0, M0, Grade Group 3 or 4 with a Gleason score of 7 or 8 and PSA levels less than 20. They are spread within the prostate, with the cancer contained in both the lobes.
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?
Diagnosis With The Whitmore
The Whitmore-Jewett System is an older system. It differs from the TNM system in that the stage and sub-stage is determined by whether the tumor can be felt by a physical examination* and by the PSA score.*a digital rectal examination
- Stage B – a tumor is not detected but PSA levels are very high.
- Stage B1 – a tumor can be felt. It is confined to one lobe.
- Stage B2 – a tumor can be felt. It is found in both lobes.
The TNM system when used in conjunction with PSA and Gleason scores is generally favored over the Whitmore-Jewett system it is thought to give a more accurate diagnosis.
Stage 3 Prostate Cancer
Stage 3 prostate cancer is an advanced stage that is still localized to the area of the prostate. It does not involve the lymph nodes and has not metastasized to distant sites . People with Gleason scores of 8 or more have a lower 15-year survival rate than those with lower cancer grades. Stage 3 is further divided into subgroups based on the extent and grade of the cancer :
- Stage 3ACancer is in one or both sides of the prostate Gleason grade group 14 PSA levels at least 20 ng/ml
- Stage 3BCancer has spread from the prostate to the seminal vesicles or other nearby structures like the rectum, bladder, or pelvic wall Gleason grade group 14 any PSA level
- Stage 3CCancer is in one or both sides of the prostate and may or may not have spread to nearby structures Gleason grade group 5 , meaning the cells look very abnormal any PSA level
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What Is The Source Of The Information
Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on treatments for localized prostate cancer published between January 1, 2007, and March 7, 2014. The report included 52 studies and was reviewed by health care professionals, researchers, experts, and the public.
Learn More About Prostate Cancer Care At Rcca
If youve been diagnosed with prostate cancer or are concerned about potential symptoms, contact RCCA today. Our team of cancer care specialists will assess the stage of your cancer using the latest diagnostic methods and work with you to design a fully individualized care plan that includes advanced treatment options, the potential for clinical trials, and support that addresses physical and emotional well-being. To speak with a representative right away, please call .
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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.
Diagnosis With The Tnm System
When using the TNM System, a patient’s PSA and Gleason scores are usually considered. Using the TNM system Stage 2 prostate cancer can be:
Stage 2a: prostate cancer cells are confined to one lobe, the PSA is less than 10 and the Gleason score 6 or less.
Stage 2b: prostate cancer cells are found in both lobes, or, cancer cells are found in one lobe and the PSA score is equal to or greater than 20, or, the Gleason score is equal to or greater than 8.
The main difference between the Stage 1 grade and Stage 2a grade is that at Stage 2a the PSA and/or Gleason score is higher. Whilst there are there are typically more prostate cancer cells at stage 2, they are still confined to the prostate gland and have not spread.
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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.
What Is Prostate Cancer
Prostate cancer is the most common non-skin cancer affecting men in the United States. It is estimated that 11% of men will be diagnosed with prostate cancer at some point in their lives and 2.5% will die from it .
The prostate gland is about the size of a walnut, and sits at the base of the bladder in front of the rectum. Its main job is to make prostatic fluid that helps keep your sperm healthy.
In prostate cancer, abnormal cells begin slowly growing in the peripheral zone of the prostate gland . If undetected, cancer may grow and spread beyond the prostate gland via three potential routes:
- Growing into adjacent tissues
- Spreading through the lymph nodes into the lymph system
- Traveling in the bloodstream to distant tissues, like bone, lung or liver
If your healthcare provider suspects prostate cancer, you will need a prostate biopsy. During this procedure, a small sample of prostate cells from the tumor is removed and evaluated under a microscope. This biopsy, along with other tests like ultrasound, CT, MRI, etc. will help establish the grade and stage of your cancer to determine the best course of treatment.
Prostate Cancer: Stages Grades And Treatment
Cancer stage refers to the size of the tumor and whether or not it has spread to other parts of the body prostate cancer is staged using the TNM system. Cancer grade refers to how quickly the cancer cells will grow and spread prostate cancer is graded using the Gleason score. Treatment of prostate cancer is based on a combination of age, life expectancy, and personal preferences, in addition to cancer grade and stage. In general, the higher the grade or stage, the more likely it is that the cancer will spread.
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.
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What Will Happen After My Treatment
You will have regular check-ups during and after your treatment to check how well it is working. You may hear them called follow-up appointments. Youll have regular PSA blood tests ask the people treating you how often youll have these. If your PSA level goes down this usually suggests your treatment is working.
Tell your doctor or nurse about any side effects youre getting. There are usually ways to manage side effects.
Make sure you have the details of someone to contact if you have any questions or concerns between check-ups. This might be your specialist nurse or key worker. You can also speak to our Specialist Nurses.
Read more about follow-up after prostate cancer treatments.
What Does Staging And Grading Mean For Treatment
These two numbers are the most important for determining your future course of treatment. Some treatments are only effective for Stages I and II, where the cancer is still confined to the prostate. Some other treatments only become necessary at Stages III and IV, where the cancer has spread outside the prostate.
Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with treatment. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance and avoid side effects.
In any case, the stage and grade should be a vital component of any discussion with your doctor.
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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.
The Number Staging System
There are a few different systems used for staging prostate cancer. A simplified number staging system is described below.
- Stage 1 The tumour is contained in the prostate. The tumour is too small to be felt when a doctor does a rectal examination or to be seen on a scan.
- Stage 2 The tumour is still contained in the prostate, but your doctor can feel it when they do a rectal examination.
- Stage 3 The tumour has started to break through the outer capsule of the prostate and may be in the nearby tubes that produce semen .
- Stage 4 The tumour has spread outside the prostate. It may have spread to areas such as the bladder or back passage . Or it may have spread further, for example to the bones.
Using the numbered staging system described above:
- stage 4 is known as advanced prostate cancer.
The grade of a cancer gives an idea of how quickly the cancer might grow or spread. A doctor decides the grade of the cancer by how the cancer cells look under the microscope.
Doctors look at the grade of the cancer to help them plan your treatment.
Gleason is the most commonly used grading system for prostate cancer.
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Pathological Stage: A Look At The Actual Cancer Cells And Their Distribution Within The Pelvic Area
This system assesses how pervasive the cancer cells are within and around the prostate. These stages begin at T2.
T2: The tumor is located in the prostate only.T3: The tumor has breached the prostate border on 1 or more sides.T3b: The tumor has begun to grow in the seminal vesicles.T4: The tumor has grown into other neighboring structures, like the bladder, the rectum, or the pelvic wall.
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.
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How Prostate Cancer Staging Is Done
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.
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
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