How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
Clinical Outcomes For Patients With Gleason Score 910 Prostate Adenocarcinoma Treated With Radiotherapy Or Radical Prostatectomy: A Multi
- Amar U. KishanCorrespondenceCorresponding author. Department of Radiation Oncology, Suite B265, 200 Medical Plaza, Los Angeles, CA 90095, USA. Tel. +1 825 9771 Fax: +1 825 7194.
- Department of Radiation Oncology, University of California, Los Angeles, CA, USADepartment of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USADepartment of Urology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Diagnosed In March 2020 Prostate Cancer
I just found this group tonoght My husband is 65 He is diagnosed with prostate cancer that has spread to his bones and pelvis as well His PSA is 23 He had biopsy in April along with bone scan and MRI He had a pain pump unplanted 2 weeks ago to control pain as Oxycotin was not helping He recently had a 3 injections at cancer center I do not have the names with me but I know after a month he is going to start Fermagon?? He started taking chemo pills last Thursday Aeateda?? I will get correct names and post again later As you can tell I am VERY new and do not know what questions I should be asking His next appoint ment is May 7 Please let me know what I should be asking His Gleason is 9 Please I need all the advice I can get to help my husband live a normal life as possible Thank you
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Whats The Best Way To Treat Localized Gleason 9
EBRT plus brachytherapy and ADT appeared to afford the best outcomes.
The most aggressive localized prostate cancer has a Gleason score of 9-10. Whats the best way to treat it? Radiation oncologist Phuoc Tran, M.D., Ph.D., and colleagues recently took part in a multi-institutional study to find out. Their results were published in the Journal of the American Medical Association .
Investigators at 12 hospitals in the United States and Norway compared the clinical outcomes of 1,809 men with Gleason score 9-10 prostate cancer after they had either radical prostatectomy, external-beam radiation therapy with androgen deprivation therapy , or EBRT plus a brachytherapy boost with ADT the men were treated between 2000 and 2013. Of these men, 639 underwent radical prostatectomy, 734 had EBRT and ADT, and 436 had EBRT plus brachytherapy, along with ADT.
We found that treatment with either EBRT and ADT or radical prostatectomy appeared to be equivalent but EBRT plus brachytherapy and ADT appeared to afford the best outcomes of the three.
This work was published with Hopkins co-investigators Ashley Ross, Jeff Tosoian, Stephen Greco, Curtiland DeVille, Todd McNutt, Daniel Y. Song, and Theodore L. DeWeese.
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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:
Ajcc Stage Groupings And Tnm Definitions
The AJCC has designated staging by TNM classification.
| Grade Group | Gleason Score | Gleason Pattern |
|---|---|---|
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | ||
| 1 | ||
| 4+4, 3+5, or 5+3 | ||
| 5 | 4+5, 5+4, or 5+5 |
| Stage | Gleason Score Gleason Pattern g | Illustration | |
|---|---|---|---|
| T = primary tumor N = regional lymph nodes M = distant metastasis cT = clinical T PSA = prostate-specific antigen pT = pathological T. | |||
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | |||
| The explanations for superscripts b through g are at the end of Table 5. | |||
| I | cT1ac, cT2a, N0, M0 | cT1 = Clinically inapparent tumor that is not palpable. | < 10 |
| cT1a = Tumor incidental histologic finding in 5% of tissue resected. | |||
| cT1b = Tumor incidental histologic finding in > 5% of tissue resected. | |||
| cT1c = Tumor identified by needle biopsy found in one or both sides, but not palpable. | |||
| cT2 = Tumor is palpable and confined within prostate. | |||
| cT2a = Tumor involves 1/2 of one side or less. | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. | |||
| Gleason Score, 6 Gleason Pattern, 3+3 . | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. |
References
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The Initial Causes What Is A Pt3a Prostate Cancer
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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Stages Of Prostate Cancer
|
Any T, any N, M1 Any Grade Group Any PSA |
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.
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General Information About Prostate Cancer
In This Section
The median age at diagnosis of carcinoma of the prostate is 67 years. Prostate cancer may be cured when localized, and it frequently responds to treatment when widespread. The rate of tumor growth varies from very slow to moderately rapid, and some patients may have prolonged survival even after the cancer has metastasized to distant sites, such as bone. The 5-year relative survival rate for men diagnosed in the United States from 2011 to 2017 with local or regional disease was greater than 99%, and the rate for distant disease was 31% a 98% survival rate was observed for all stages combined. The approach to treatment is influenced by age and coexisting medical problems. Side effects of various forms of treatment should be considered in selecting appropriate management.
Many patientsespecially those with localized tumorsmay die of other illnesses without ever having suffered disability from the cancer, even if managed conservatively without an attempt at curative therapy. In part, these favorable outcomes are likely the result of widespread screening with the prostate-specific antigen test, which can identify patients with asymptomatic tumors that have little or no lethal potential. There is a large number of these clinically indolent tumors, estimated from autopsy series of men dying of causes unrelated to prostate cancer to range from 30% to 70% of men older than 60 years.
Hormonal Therapy And Its Complications
Several different hormonal approaches are used in the management of various stages of prostate cancer.
These approaches include the following:
- Abiraterone acetate .
- Aminoglutethimide.
Abiraterone acetate
Abiraterone acetate has been shown to improve OS when added to ADT in men with advanced prostate cancer who have castration-sensitive disease. Abiraterone acetate is generally well-tolerated however, it is associated with an increase in the mineralocorticoid effects of grade 3 or 4 hypertension and hypokalemia compared with ADT alone. It may also be associated with a small increase in respiratory disorders.
Bilateral orchiectomy
Benefits of bilateral orchiectomy include the following:
- Ease of the procedure.
- Immediacy in lowering testosterone levels.
- Low cost relative to the other forms of ADT.
Disadvantages of bilateral orchiectomy include the following:
- Psychological effects.
Bilateral orchiectomy has also been associated with an elevated risk of coronary heart disease and myocardial infarction.
Estrogen therapy
Estrogens at a dose of 3 mg qd ofdiethylstilbestrol will achieve castrate levels of testosterone. Likeorchiectomy, estrogens may cause loss of libido and impotence. Estrogens also cause gynecomastia, and prophylactic low-dose radiation therapy to the breasts is given to prevent this complication.
Luteinizing hormone-releasing hormone agonist therapy
Evidence :
Antiandrogen therapy
ADT
Evidence :
Antiadrenal therapy
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Radiation Therapy And Radiopharmaceutical Therapy
External-beam radiation therapy
Candidates for definitive radiation therapy must have a confirmed pathologic diagnosis of cancer that is clinically confined to the prostate and/or surrounding tissues . Staging laparotomy and lymph node dissection are not required.
Radiation therapy may be a good option for patients who are considered poor medical candidates for radical prostatectomy. These patients can be treated with an acceptably low complication rate if care is given to the delivery technique.
Long-term results with radiation therapy are dependent on stage and are associated with dosimetry of the radiation.
Evidence :
Evidence :
Brachytherapy
Very Scared: Gleason 9 Prostate Cancer
Hi all
I saw my specialist last week and he informed me that I had level 9 Gleason prostate cancer. I am awaiting a CT scan and then a bone scan. I am in no pain whatsoever at the moment and I consider myself quite fit playing golf 4 times a week and walking with my wife and dog the other days. I am 60 years old and am quite scared for my future. I am not scared of the pain, just not being around for my wife and 2 grown up children.
Can anyone give me hope for optimism as all I have seen about level 9 gleason is not great.
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Tnm Staging System The Most Widely Used Staging System For Prostate Cancer Isthe Ajcc Tnm System For Prostate Cancerthere Are 4 Stages Often The Stages 1 To 4 Are Written As The Roman Numeralsi Ii Iii And Iv Generally The Higher The Stage Number The More The Cancerhas Spread The Stages Can Be Further Divided Into A B Or C An Earlier Lettermeans A Lower Stage Talk To Your Doctor If You Have Questions About Staging Tnm Staging Is Based On The Following: T Describes Thetumour And Whether Doctors Can Feel It Or See It On Imaging Tests It Alsodescribes Whether The Tumour Has Grown Outside Of The Prostate To Thesurrounding Tissues T Is Usually Given As A Number From 1 To 4 A Highernumber Means That The Tumour Takes Up More Of The Prostate Or That The Tumourhas Grown Outside Of The Prostate Into Nearby Tissues Some Stages Are Alsodivided Further Into A B Or C An Earlier Letter Means A Lower Stage The Clinical T Is Your Doctor’s Best Estimate Of Theextent Of The Cancer Based On A Physical Exam A Digital Rectal Exam A Prostatebiopsy And Imaging Tests If You Have Surgery To Remove Your Prostate Apathological T Will Be Given Pt Is More Accurate Than Ct T The Tumour Has Grown Outside The Prostate And Into The Seminal Vesicles T4 The Tumour Has Grown Outside The Prostate And Into Nearby Structures Suchas The Bladder Rectum Pelvic Muscles And Pelvic Wall
N describeswhether the cancer has spread to lymph nodes near the prostate. N0 means that thecancer hasn’t spread to any nearby lymph nodes. N1 means that it has spread tonearby lymph nodes.
M describeswhether the cancer has spread to other parts of the body. M0 means that the cancerhas not spread to other parts of the body. M1 means that it has spread to otherparts of the body.
PSA level describes the amount of the prostate-specificantigen in the blood.
Grade Group is a measureof how likely the cancer is to grow and spread.
Stage I Prostate Cancer Treatment
In This Section
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer. In the CLIN1001 PCM301 randomized trial, 413 men with low-risk cancer were randomly assigned in an open-label trial to receive either the photosensitizing agent, padeliporfin , or active surveillance. Median time to local disease progression was 28.3 months for patients receiving padeliporfin and 14.1 months for patients who were assigned to active surveillance . However, the appropriate population for photodynamic therapy may be quite narrow, as it may overtreat men with very low-risk disease and undertreat men with higher-risk disease.
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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.
Tests To Identify Prostate Cancer Stage
After a prostate cancer diagnosis, your doctor will do tests to see how far the cancer has spread. Not all men need every test. It depends on the results of your biopsy, a test that checks tissue from your prostate gland for cancer. Tests that help your doctor figure out the stage of your prostate cancer include:
- CT scan of the abdomen and pelvis to see if the cancer has spread
- Nuclear medicine bone scan to see if the cancer has spread to your bones
- Surgery to check the lymph nodes in your pelvis for prostate cancer spread
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Evaluation Of The Histologic Grade
Usually, the grade of the cancer is evaluated separately from the stage. For prostate cancer, cell morphology is graded based on the Gleason grading system.
Of note, this system of describing tumors as “well-“, “moderately-“, and “poorly-” differentiated based on Gleason score of 24, 56, and 710, respectively, persists in SEER and other databases but is generally outdated. In recent years pathologists rarely assign a tumor a grade less than 3, particularly in biopsy tissue.