The Ajcc Tnm Staging System
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main tumor *
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of the body
- The PSA level at the time of diagnosis
- The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .
*There are 2 types of T categories for prostate cancer:
- The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.
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.
Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men and anyone with a prostate aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men and anyone with a prostate of African-Caribbean African descent. It’s less common in men and anyone with a prostate of Asian descent.
Men and anyone with a prostate who have first-degree male relatives affected by prostate cancer are also at a slightly increased risk.
Read more about the causes of prostate cancer
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Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still .
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
- Gleason score: 6 or less
Other Professionals Who Can Help
Your doctor, nurse or GP can refer you to these professionals.
- Physiotherapists can help with mobility and provide exercises to help improve fitness or ease pain. This can help you stay independent for longer.
- Counsellors, psychologists or psychotherapists can help you and your family work through any difficult feelings and find ways of coping. Many hospitals have counsellors or psychologists who specialise in helping people with cancer. You can also get free counselling on the NHS without a referral from your GP. Visit nhs.uk/counselling to find out more.
- Dietitians can give you advice about healthy eating, which might help with fatigue and staying a healthy weight. They can also help if you are losing weight or having problems eating.
- Occupational therapists can provide advice and access to equipment and adaptations to help with daily life. For example, help with dressing, eating, bathing or using the stairs.
- Social services, including social workers, can provide practical and financial advice and access to emotional support. They can give you advice about practical issues such as arranging for someone to support you at home. Whats available varies from place to place. Your GP, hospital doctor or nurse might be able to refer you to some services. The telephone number for your local social service department will be in the phonebook under the name of your local authority, on their website and at the town hall.
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Causes Of Prostate Cancer
It’s not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.
These include:
- age risk rises as you get older and most cases are diagnosed in men and anyone with a prostate over 50 years of age
- ethnic group prostate cancer is more common among men and anyone with a prostate of African-Caribbean and African descent than in men and anyone with a prostate of Asian descent
- family history having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer
- obesity there may be a link between obesity and prostate cancer
- exercise men and anyone with a prostate who regularly exercises have also been found to be at lower risk of developing prostate cancer
- diet research is ongoing into the links between diet and prostate cancer a diet high in calcium is linked to an increased risk of developing prostate cancer
In addition, some research has shown that prostate cancer rates appear to be lower in men and anyone with a prostate who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed.
Read further information:
A Suggested Psa Screening Protocol
Its reasonable to start checking PSA yearly in men over the ages of 45. Men with a family history of prostate cancer or men who are African-American should start annual testing at age 40. Men over age 75 who are in good health should continue screening.
So what is the trigger level of PSA that should lead to performing a scan? As noted above, younger men who have small prostate glands should consider doing a scan if the PSA is over 2.5. In an older man, particularly if the prostate gland as determined by the finger exam is big, a PSA over 4.0 is a reasonable threshold for obtaining imaging . The PSA blood test has far surpassed the wildest dreams of the doctors who discovered it. Like any powerful tool, however, misuse can lead to over-treatment and unnecessary harm.
So much of the misinformation on the internet implies that every ache, pain, or problem located near the prostate could be caused by cancer. The fact that the most frequently asked question related to prostate cancer is about prostate cancer symptoms indicates that the public is being led into all kinds of unnecessary anxiety.
Know this: As long as the PSA is in the normal range, in general, men can rest assured that any prostate-related symptoms they are experiencing are most likely originating from something unrelated to cancer. PSA testing detects early stage prostate cancer so reliably that when the PSA is normal, one can be sure that any prostate-related symptoms are due to some other cause.
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Understanding The Nature Of Stage 4 Cancer
A person with stage 4 cancer may not feel ready to face the likelihood of death, which causes them to be willing to try any kind of treatment, even with a small chance of success, according to the study.
Sometimes, doctors do not speak in straightforward terms with patients about the limited chances of success in curing stage 4 cancer. Patients need to ask questions of doctors about the actual chances of recovery when facing stage 4 cancer. They also should ask about the benefits of hospice care, such as those outlined by the Mayo Clinic.
Should I Have A Psa Test
Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer.
A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment.
If you are thinking about asking for a PSA test, it is important that you first discuss whether it is right for you with your GP so you understand what the results might mean.
The Prostate Cancer Risk Management Programme has information on the risks and benefits of the PSA test to help you decide whether or not to have it.
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it is no longer possible to cure it. However, it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
Symptoms Of Prostate Cancer
Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra.
This normally results in problems associated with urination. Symptoms can include:
- needing to urinate more frequently, often during the night
- needing to rush to the toilet
- difficulty in starting to pee
- straining or taking a long time while urinating
- feeling that your bladder has not emptied fully
Your prostate may get larger as you get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia.
Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss.
Read further information:
- Cancer Research UK: prostate cancer symptoms
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Experimental Treatments For Advanced Prostate Cancer
Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications. These include the following:
Immune checkpoint inhibitors
The immune system uses âcheckpointsâ to stop it from attacking the bodyâs healthy cells. These checkpoints are proteins on immune cells.
Cancer cells often use these checkpoints to keep the immune system from attacking them.
Immune checkpoint inhibitors are drugs that can these checkpoints on cancer cells. Inhibiting these checkpoints can allow a personâs immune system to attack the cancer cells.
Chimeric antigen receptor T cell therapy
This treatment involves taking immune cells from the personâs blood. A scientist then alters these cells in a lab to have receptors called chimeric antigen receptors on their surface.
These receptors help the cells attach to proteins on the surface of prostate cells. A scientist then multiplies these altered T cells in a lab before putting them back into the personâs blood.
Scientists hope these T cells can then find prostate cancer cells and launch a targeted immune attack.
However, this treatment is complicated and may have some serious side effects. This means it is currently only available as part of clinical trials.
Targeted drug therapies
Targeted drug therapies can act on specific parts of cancer cells and the environments surrounding them.
These drugs
Two possible targeted therapy treatments are:
Treating prostate cancer that has spread to the bones
Coping With Prostate Cancer
The diagnosis of cancer can cause great anxiety to the individual and his family and friends. At times, one may have troubles coping with the diagnosis, the disease, and its treatment. Searching online for information may prove overwhelming also and may not be the best resource. Ask your physician or local hospital about local resources. Often, there are local prostate cancer support groups which may help you cope with your feelings and provide local resources for more knowledge.
You may consider contacting one or more of the following organizations:
- US Prostate Cancer Foundation,
- Centers for Disease Control and Prevention ,
- American Cancer Society, and
- Patient Advocates for Advanced Cancer Treatment.
The Internet has provided access to a number of sites focusing on prostate cancer treatment and outcomes. The National Cancer Institute and the National Comprehensive Cancer Network have patient information, as well as the American Urological Association.
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Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. Thats because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes not their prostate cancer.
Is Metastatic Cancer Always Terminal
This cancer stage has high mortality risk. However, in most cases, stage 4 or metastatic cancer is not always terminal. It is all depending on the spread area and case. On the other hand, it is also the stage where more advanced and aggressive treatment is necessary to kill the cancer cell.
Terminal cancer refers to a cancer case that is impossible to cure. This case mostly will result in the death of the patient. Therefore, the treatment for terminal cancer is only to control the spread and ease the patients pain. The curing process is difficult to do. So, it is the period when doctors and patients families prepare for the worst.
Despite its obvious result, the medical world still sets the standard for the patients survival likelihood. And, to learn more about that matter, you can continue reading. We will start talking about our main topic here, the stage 4 cancer life expectancy.
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
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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Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues55 reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.56
Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can have an effect on your life. As well as causing physical problems such as erectile dysfunction and urinary incontinence, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a family doctor and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
Read more about living with prostate cancer
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