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.
A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
Table 5 Definitions Of Tnm Stages Iva And Ivba
| Gleason Score Gleason Pattern g | Illustration | |||
|---|---|---|---|---|
| Any T = See descriptions in , Stage IIIC. | See Any PSA values in , Stage IIIC. | Gleason Score, 6 Gleason Pattern, 3+3 . | ||
| Gleason Score, 7 Gleason Pattern 3+4 . | ||||
| Gleason Score, 7 Gleason Pattern, 4+3 . | ||||
| N1 = Metastases in regional node. | Gleason Score, 8 Gleason Pattern, 4+4, 3+5, or 5+3 . | |||
| M0 = No distant metastasis. | Gleason Score, 9 or 10 Gleason Pattern, 4+5, 5+4, or 5+5 . | |||
| IVB | Any T, Any N, M1 | Any T = See descriptions in , Stage IIIC. | See Any PSA values , Stage IIIC. | Any Gleason Score Gleason Pattern = See above in Stage IVA. |
| NX = Regional nodes were not assessed. | ||||
| N0 = No positive regional nodes. | ||||
| N1 = Metastases in regional node. | ||||
| M1 = Distant metastasis. | ||||
| M1b = Bone. | ||||
| M1c = Other site with or without bone disease. |
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Standard Treatment Options For Stage I Prostate Cancer
Standard treatment options for patients with include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radicalprostatectomy may be difficult after a transurethral resection of the prostate .
Because about 40% to 50% of men with clinically organ-confined disease are found to have pathologic extension beyond the prostate capsule or surgical margins, the role of postprostatectomy adjuvant radiation therapy has been studied.
Evidence :
Evidence :
Stage 2 Breast Cancer
The tumor measures between 2 cm and 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. The cancer cells have spread beyond the original location and into the surrounding breast tissue, and a tumor may be detected during a breast self-exam as a hard lump.
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Castrate Resistant Prostate Cancer
Eventually, almost all metastatic prostate cancers become resistant to androgen ablation. In patients with castrate serum testosterone levels , castrate-resistant prostate cancer is defined as 2-3 consecutive rises in PSA levels obtained at intervals of greater than 2 weeks and/or documented disease progression based on findings from computed tomography scan and/or bone scan, bone pain, or obstructive voiding symptoms.
Rarely, a rise in PSA may reflect failure of LHRH treatment to control testosterone secretion, rather than the development of castrate-resistant disease. Therefore, the testosterone level should be measured when the PSA rises. If the serum testosterone level exceeds castrate levels, changing the antiandrogen therapy may drop the PSA and delay the need for other therapy.
Prior to the development of the most recent therapies, the median time to symptomatic progression after a rise in the PSA level of more than 4 ng/mL was approximately 6-8 months, with a median time to death of 12-18 months. Since then, however, the latter figure has increased.
Little information is available about the impact of maintaining hormone suppression when androgen-independent progression occurs, but the general consensus among specialists is that the treatment should continue. The reasoning is that tumor cells are still hormone sensitive and may grow faster if the testosterone is permitted to rise.
- Megestrol
- Suramin
- Estrogen
Docetaxel
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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Medically Reviewed By Dr Ch Weaver Md Medical Editor 1/2021
Prostate cancer is referred to as stage II when the cancer can be detected by a digital rectal examination or an elevated prostate-specific antigen , and there is no evidence that the cancer has spread outside the prostate to other organs. Stage II disease may also be further divided into the following depending on how much tissue is involved in the tumor :
- T2a: The cancer involves half or less of a lobe of the prostate.
- T2b: The cancer involves half or more of a lobe of the prostate, but the other section isnt involved at all.
- T2c: The cancer involves both lobes of the prostate.
Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides whats called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, were not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 96%
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The Stages Of Prostate Cancer: What You Need To Know
After a prostate cancer diagnosis, your oncologist will refer to the stage of your cancer. All cancers are categorized into four distinct stages, each of which identifies the progress of the growth of cancerous cells within clinically defined standards. These stages help doctors determine the most appropriate care for each patient based on his or her condition, and can also provide easy-to-understand context for your diagnosis. Learn more about the stages of prostate cancer, how each stage will affect your treatment plan and the survival rates for each stage, then contact Regional Cancer Care Associates to schedule a consultation.
Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back in the area of the prostate after surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
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Stereotactic Body Radiation Therapy
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.
The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate
The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the semen.
Prostate cancer is most common in older men. In the U.S., about 1 out of 8 men will be diagnosed with prostate cancer.
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Standard Treatment Options For Stage Ii Prostate Cancer
Standard treatment options for patients with include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent. .
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radical prostatectomy may be difficult after a transurethral resection of the prostate .
Evidence :
Evidence :
Evidence :
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
- chemotherapy
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Stage 2 Prostate Cancer Symptoms
Symptoms for stage 2 prostate cancer often center around sexual and urinary problems. Each case is different, and people diagnosed with stage 2 prostate cancer may not experience all of these symptoms.
Sexual Problems
- Impotence – a man may have difficulty having an erection or maintaining an erection.
- Hematospermia – a condition in which there is blood in the semen.
- Painful ejaculations
- Pain when urinating – a burning sensation may be experienced
- Blood in the urine
Eight Types Of Standard Treatment Are Used:
Watchful waiting or active surveillance
Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.
Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.
Surgery
Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:
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Diagnosing Stage 2 Prostate Cancer
A stage 2 prostate cancer diagnosis can only be made after a number of tests have been given. Such tests may include:
A Needle Biopsy : a needle is inserted into the seminal vesicles, which are glands connected to the prostate, and a sample of fluid is taken. This sample is then analyzed using a microscope. If a certain level of cancerous cells are found and the cancer is still localized to the prostate, a diagnosis of second stage prostate cancer may be made.
Imaging Tests: MRI or CT scans determine whether tumors are present and the cancer has spread.
Digital Rectal Examination: a finger is inserted in the rectum to feel for any abnormalities of the prostate area.
PSA Test: prostate-specific antigen is a protein created in the prostate gland and found in the blood. Higher levels of PSA may indicate prostate cancer .
Gleason Test: the Gleason grading system assesses how aggressive a cancer is. The arrangement of cancer cells are examined underneath a microscope and patterns of cells are graded.
After the relevant tests have been taken, prostate cancer can be staged using a four stage system.
Currently, there are two main systems used to stage prostate cancer. The TNM system uses four categories 1-4 and the Whitmore-Jewett system uses four categories: A-D.