Metastases: Whether The Cancer Has Spread
The spread of cancer is measured in two ways: by lymph node involvement, and by its appearance in other organs or parts of the body, or metastasis.
Lymph node staging, or N-staging, determines whether the cancer is present in nearby lymph nodes. Lymph nodes are tiny organs that are part of the immune system.NX: The regional lymph nodes cannot be evaluated.N0: The cancer has not spread to lymph nodes in the immediate area.N1: The cancer has spread to lymph nodes in the pelvic region.
The M in the TNM system indicates whether the prostate cancer has spread to other parts of the body, such as the lungs or the bones. This is called distant metastasis.
MX: Metastasis cannot be evaluated.M0: The cancer has not metastasized beyond the immediate prostate region.M1: The cancer has metastasized deeper into the body.
- M1a: The cancer has spread to lymph nodes away from the groin area.
- M1b: The cancer has spread to the bones.
- M1c: The cancer has spread to another part of the body, with or without spread to the bones.
The combination of your full staging results, including your grade and your T, N, and M stages, paints a more complete picture of how the cancer is progressing. This enables your doctors to determine which treatments have the best chance or controlling or eradicating your cancer.
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Life Expectancy And Survival Rates
Generally speaking, the earlier prostate cancer is detected, the more likely treatment will be successful. Once the cancer has begun to spread outside the prostate, treatment is likely to shift away from attempts to cure the disease and toward methods to help reduce the rate of spread, lengthen life and keep the symptoms under control, according to UCLA Health.
Unlike most prostate cancer diagnoses, for which the five-year survival rate is nearly 100 percent, the five-year survival rate for prostate cancer in the advanced stages may be less, depending on where the cancer has metastasized to. For instance, with regional metastasis , the five year survival rate is nearly 100 percent, but distant metastasis , has a five-year survival rate of just 30 percent, according to the National Cancer Institutes Surveillance, Epidemiology and End Results database.
The stage of the disease at diagnosis is a better predictor of survival than age is. Studies of age as a predictor of survivability have been inconsistent. An analysis of data, published in the journal Urology in December 2014, noted that some research has shown higher rates of survival among younger patients while other research has indicated that younger men typically develop prostate cancer that is aggressive, advanced and quickly fatal.
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Can The Cancer Stage Change
Once diagnosed, a cancers stage never changes. Even if the patient improves or gets worse, their cancer is the same as when diagnosed.
Once diagnosed with stage 4 cancer, you will always have stage 4 cancer. That doesnt mean that you cannot sustain a long period of disease-free survival.
Part of the reason for this is statisticalstages help scientists track and reevaluate survival statistics and treatment protocols. But they also let doctors track the efficacy of treatments for your stage.
Doctors use cancer stages to compare patients with similar diagnoses, to more easily study the effectiveness of treatments, to track a persons cancer progression, and as a way to estimate survival rates for specific cancers.
Part of the confusion regarding staging status arises from the fact the disease is sometimes re-staged. Re-staging determines if there has been a progression or remission of the disease.
If cancer is re-staged or recurs , doctors keep the initial staging diagnosis and add a new stage to the patients diagnosis. New staging diagnoses get differentiated with letterslike c for clinical, p for pathological , or y for after treatment.
For instance, stage 2 breast cancer that suddenly spreads to the lungs is stage 2 breast cancer with lung metastases rather than stage 4 breast cancer. Similarly, if stage 4 breast cancer meets the definition of remission after treatment, they describe it as stage 4 breast cancer with no evidence of disease.
Prostate Cancer Stages Based On Standard Scores
After calculating the TNM categories, your doctors will combine your TNM score, Gleason score and PSA levels to assign of a specific stage to your prostate cancer. Keep in mind that every case is different, and statistics and other recommendations are purely general guidelines.
|10 years||15 years|
*Percentages factor in all stages of prostate cancer. Relative survival rate means the percentage of patients who live x number of years after their initial diagnoses, not after stoppage of treatment.
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Diagnosing Stage 4 Prostate Cancer
There are two systems which physicians often use to determine the stage of prostate cancer: the TNM & the Jewett System. Both systems use a four grade scale.
With the TNM system, final stage prostate cancer is stage 4 the final stage of the Jewett System is stage D. Therefore, using both systems, if prostate cancer has spread to areas outside the prostate gland, other than the seminal vesicles, then it is classed as stage 4 or stage D.
If the tumor has extended through the prostate gland cover, and the seminal vesicles are the only affected area outside the prostate, then the cancer is Stage 3 .
What Is Localized Prostate Cancer
Prostate cancer is the abnormal growth of cells in the prostate gland. Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesnt cause symptoms.
Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.
Men of African descent have the highest rates of both prostate cancer and deaths from it.
About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 1 In the United States, about 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime in their lifetime.footnote 2 But most men who are diagnosed with prostate cancer dont die from prostate cancer.
Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery.
Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.
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Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.
What Are The Stages Of Prostate Cancer
Cancer staging is first described using what is called a TNM system. The “T” refers to a description of the size or extent of the primary, or original, tumor. “N” describes the presence or absence of, and extent of spread of the cancer to lymph nodes that may be nearby or further from the original tumor. “M” describes the presence or absence of metastases — usually distant areas elsewhere in the body other than regional lymph nodes to which the cancer has spread. Cancers with specific TNM characteristics are then grouped into stages, and the stages are then assigned Roman numerals with the numerals used in increasing order as the extent of the cancer being staged increases or the cancer prognosis worsens. Prognosis is finally reflected by considering the patient’s PSA score at presentation as well as their Gleason score in assigning a final stage designation.
The American Joint Commission on Cancer system for prostate cancer staging is as follows:
Traditionally, advanced prostate cancer was defined as disease that had widely metastasized beyond the prostate, the surrounding tissue, and the pelvic lymph nodes and was incurable. However, a more contemporary definition includes patients with lower grade disease with an increased risk of progression and/or death from prostate cancer in addition to those with widely metastatic disease.
The National Cancer Institute and the National Comprehensive Cancer Network guidelines on prostate cancer version 2.2017 indicate the following:
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Some Cancer Survival Statistics
Well, today were losing one person out of every two people with cancer. Now look back a 100 years ago. You know cancer wasnt even talked about hardly at all. And now were losing one out of two!
And the veterinarians are worse off than the medical doctors. Theyre losing one dog out of every 1.85 dogs. And Ive got some veterinarians now that are very excited about my program. Because I told them You guys are worse than the medical profession. What do you mean?! What do you mean?! I kind of get under their hide a little bit. Then I tell them, Listen, heres the reason. Or heres the statistics on it. 1 out of every 1.85 dogs die of cancer today. 1 out of 2 people die of cancer. So the medical doctors are doing a horrible job but theyre doing a better job than you guys are. Well then, he asks me, What do you think the reason is for that, Dennis?
Heres a vet asking me! Im not a vet, but I have the answer. I said If you could recommend a scientific dog food, and the other kind of dog foods out there, its the food thats killing people and killing dogs and giving them cancer. Thats why theyre dying. Really? I said Yeah, really. So we talked about that, and because I gave him that challenge What would you do? and so I told him. And so now hes enjoying some high, high, high survival rates with his pets, cats and dogs, so forth.
The Most Common Symptoms Of Stage 3 Mesothelioma Include:
- Shortness of breath
- Fluid buildup
- Weight loss
As the tumors continue to grow and spread throughout the chest, symptoms will become more problematic. Stage 3 symptoms vary from patient to patient depending on where the cancer is spreading and if the tumor mass damages vital organs. Some patients may experience referred pain felt in the neck, back or shoulders.
A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties. Pleural mesothelioma tumors also cause increased pleural fluid, which puts pressure on the lungs. Symptoms and characteristics of stage 3 mesothelioma vary based primarily on cancer type.
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How Is Prostate Cancer Staged
Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.
The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.
The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.
- Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
- The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
- Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.
How Is Advanced Prostate Cancer Diagnosed
If youve previously been diagnosed with prostate cancer, be sure to tell your doctor if you have any new symptoms, even if youve completed treatment.
To determine if prostate cancer has returned or has spread, your doctor will likely order some imaging tests, which may include:
- PET scans
- bone scans
You probably wont need all of these tests. Your doctor will choose the tests based on your symptoms and physical exam.
If any of the images reveal abnormalities, it doesnt necessarily mean that you have cancer. Additional testing may be necessary. If they find a mass, your doctor will probably order a biopsy.
For a biopsy, your doctor will use a needle to remove samples from the suspicious area. A pathologist will then analyze the removed cells under a microscope to see if theyre cancerous. The pathologist can also determine if you have an aggressive form of prostate cancer.
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Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
Staging Of Prostate Cancer
- Stage I : The Gleason score is 6 or less, and the PSA level is less than 10. Cancer at this stage is normally not detectable in an ultrasound test or in a DRE test, as the tumor is very small. It is within the prostate and has not spread to nearby lymph nodes. It is usually discovered accidentally during a surgery carried out for another purpose. Prostate ultrasound and biopsy can be performed after detection of elevated blood PSA levels.
- Stage II : From this stage onwards, the Gleason score and the PSA level may vary from person to person. As the tumor grows in size, it can be detected in a DRE test or sonogram, but the tumor is still confined to the prostate gland. It is in one half or less of only one side of the prostate. It hasnt spread to lymph nodes and nearby organs, or it has spread to nearby lymph nodes, but has not invaded nearby organs.
- Stage III : The cancerous cells spread out from the original site and invade the seminal vesicles. They do not spread to nearby lymph nodes or to nearby organs in the body.
- Stage IV : The cancer moves out of the seminal vesicles and invades the lymph nodes. The size and number of tumors increase, and the cancerous cells spread into the nearby organs, such as the bladder and the rectum. In stage four prostate cancer, even bones and other parts of the body like lungs and liver are likely to be invaded by the cancerous cells.
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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.
Survival Statistics For Prostate Cancer
Survival statistics for prostate cancer are very generalestimates and must be interpreted very carefully. Because these statistics are based on the experience of groupsof people, they cannot be used to predict a particular person’s chances ofsurvival. In general, most men diagnosed with prostate cancer do not die from thedisease itself and will die from other causes.
There are manydifferent ways to measure and report cancer survival statistics. Your doctorcan explain the statistics for prostate cancer and what they mean to you.
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Overview Of The Staging System
After a thorough assessment by your oncologist, your cancer will be assigned a stage between I and IV. Prostate cancer stages are based on the American Joint Committee on Cancer TNM system. Using the TNM system, your oncologist:
- Examines the tumor
- Determines if the cancer has spread to any lymph nodes
- Assesses whether the cancer has metastasized
- Considers the prostate-specific antigen level from blood testing
- Assigns a grade group based on how abnormal the cancer appears under a microscope
With this information in mind, you can better understand how stages are assigned and what they mean for patients in general.
What Is Prostate Cancer
The prostate lies below the bladder and in front of the rectum. In men, the size of the prostate increases with increasing age. In younger men, it is about the size of a walnut. Its primary function is to make fluid to nourish the semen.
Growth in the prostate can be of two types
Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.
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