The Stages

Here are the various procedures available to move towards an accurate diagnosis:

Understanding The Stages

 

If you’ve been diagnosed with prostate cancer, you’ll need to have further tests to determine if the cancer has spread in the prostate or to other parts of the body. Staging is the term used to refer to the stage of the cancer and indicates the spread of the disease in the body. Staging is also used to plan treatment strategies.

In order to determine the stage of prostate cancer, the results of previous tests will be used (such as your PSA result) as well as results of other procedures, including:

 

A Bone Scan

This is used to check for cancer cells in the bone. A small amount of radioactive material is injected into your vein, travels through the bloodstream and collects in any abnormal cells in the bones. A scanner is used to look for collections of radioactive material.

MRI Scan

This can demonstrate differences between normal and diseased parts of prostate tissue and assess whether cancer infiltrates the capsule of the prostate gland and/or other pelvic tissues outside of the prostate gland. An MRI scan also looks for lymph node involvement.

CT or CAT Scan

This gives an assessment of the prostate gland position, its appearance and its relationship to other pelvic organs. It also helps plan radiation therapy.

Pelvic Lymphadenectomy

This is a surgical procedure to remove the lymph node of the pelvis. Cells are then taken from the lymph node and viewed by a pathologist under a microscope to look for cancer cells.

Seminal Vesicle Biopsy

A needle is used to remove fluid from the seminal vesicle, which makes semen. The fluid is viewed by a pathologist under a microscope to look for the presence of cancer cells.

The most widely used staging system for prostate cancer is the American Joint Committee on Cancer (AJCC) TNM system.

The TNM system for prostate cancer is based on 5 key pieces of information:

  1. The extent of the primary tumour (T1 to T4 category)
  2. Whether the cancer has spread to nearby lymph nodes (N0 to N1 category)
  3. The absence or presence of distant metastasis (M0 to M1 category)
  4. The PSA level at the time of diagnosis
  5. The Gleason score

There are 2 types of staging for prostate cancer:

The Clinical Stage

The clinical stage is your doctor’s best estimate of the extent of your disease, based on the results of the physical exam (including DRE), laboratory tests, prostate biopsy, and any imaging tests you’ve had

The Pathologic

The pathologic stage, which is based on the surgery and examination of the removed tissue

T Categories (clinical)

There are 4 categories for describing the local extent of a prostate tumour, ranging from T1 to T4. Most of these have subcategories as well.

Your doctor can’t feel the tumor or see it with imaging such as trans-rectal ultrasound.

 

  • T1a: Cancer is found incidentally (by accident) during a transurethral resection of the prostate (TURP) that was done for benign prostatic hyperplasia (BPH). Cancer is in no more than 5% of the tissue removed
  • T1b: Cancer is found during a TURP but is in more than 5% of the tissue removed
  • T1c: Cancer is found by needle biopsy that was done because of an increased PSA

Your doctor can feel the cancer with a digital rectal exam (DRE) or see it with imaging such as trans-rectal ultrasound, but it still appears to be confined to the prostate gland.

T2a: The cancer is in one half or less of only one side (left or right) of your prostate
T2b: The cancer is in more than half of only one side (left or right) of your prostate
T2c: The cancer is in both sides of your prostate

The cancer has grown outside your prostate and may have grown into the seminal vesicles

 

  • T3a: The cancer extends outside the prostate but not to the seminal vesicles
  • T3b: The cancer has spread to the seminal vesicles

The cancer has grown into tissues next to your prostate (other than the seminal vesicles), such as the urethral sphincter, the rectum, the bladder, and/or the wall of the pelvis.

N Categories (clinical)

 

N categories describe whether the cancer has spread to nearby (regional)
lymph nodes

 

Nearby lymph nodes were not assessed

    The cancer has not spread to any nearby lymph nodes

    The cancer has spread to one or more nearby lymph nodes

      M Categories (clinical)

       

      M categories describe whether the cancer has spread to distant parts of the body. The most common sites of prostate cancer spread are to the bones and to distant lymph nodes, although it can also spread to other organs, such as the lungs and liver.

       

      The cancer has not spread past nearby lymph nodes

        The cancer has spread beyond the nearby lymph nodes

        The cancer has spread to distant (outside of the pelvislymph nodes

          The cancer has spread to the bones

          The cancer has spread to other organs such as lungs, liver, or brain (with or without spread to the bones).

          Stage Grouping

          Once the T, N, and M categories have been determined, this information is combined, along with the Gleason score and PSA level, in a process called stage grouping. If the Gleason score or PSA results aren’t available, the stage can be based on the T, N, and M categories. The overall stage is expressed in Roman numerals from I (the least advanced) to IV (the most advanced). This is done to help determine treatment options and the outlook for survival or cure (prognosis).

          Stage 1:
          One of the following applies

          T1, N0, M0, Gleason score lower than 6, PSA less than 10

          The doctor can’t feel the tumour or see it with an imaging test such as trans-rectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer is still within the prostate and hasn’t spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10.

          OR

          T2a, N0, M0, Gleason score lower than 6, PSA less than 10:

          The tumour can be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound and is in one half or less of only one side (left or right) of the prostate [T2a]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10.

          Stage 2A:
          One of the following applies

          T1, N0, M0, Gleason score of 7, PSA less than 20

          The doctor can’t feel the tumour or see it with imaging such as trans-rectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA level) [T1]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour has a Gleason score of 7. The PSA level is less than 20.

          OR

          <br /> T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20

          The doctor can’t feel the tumour or see it with imaging such as trans-rectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour has a Gleason score of 6 or less. The PSA level is at least 10 but less than 20.

          OR

          T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20

          The tumour can be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound and is in only one side of the prostate [T2a or T2b]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. It has a Gleason score of 7 or less. The PSA level is less than 20.

          Stage 2B:
          One of the following applies

          T2c, N0, M0, any Gleason score, any PSA

          The tumour can be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound and is in both sides of the prostate [T2c]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.

          OR

          T1 or T2, N0, M0, any Gleason score, PSA of 20 or more

          The cancer has not yet spread outside the prostate. It may (or may not) be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score. The PSA level is at least 20.

          OR

          T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA

          The cancer has not yet spread outside the prostate. It may (or may not) be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 8 or higher. The PSA can be any value.

          Stage 3:
          One of the following applies

          T3, N0, M0, any Gleason score, any PSA

          The cancer has grown outside the prostate and may have spread to the seminal vesicles [T3], but it has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.

          Stage 4:
          One of the following applies

          T4, N0, M0, any Gleason score, any PSA

          The cancer has grown into tissues next to the prostate (other than the seminal vesicles), such as the urethral sphincter rectum, bladder, and/or the wall of the pelvis [T4]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.

          OR

          Any T, N1, M0, any Gleason score, any PSA

          The tumour may or may not be growing into tissues near the prostate [any T]. The cancer has spread to nearby lymph nodes [N1] but has not spread elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.

          OR

          Any T, any N, M1, any Gleason score, any PSA

          The cancer may or may not be growing into tissues near the prostate [any T] and may or may not have spread to nearby lymph nodes [any N]. It has spread to other, more distant sites in the body [M1]. The tumour can have any Gleason score and the PSA can be any value.

          Risk Stratification

           

          Risk stratification is performed taking into account all of the above factors. This allows for you and your doctor to plan your treatment and assess possible outcomes with long-term prognosis.

          • Clinical stage is T1c
          • Gleason score is 2-6
          • PSA is less than 10 ng/ml
          • Fewer than 3 biopsy cores positive, less than 50% of cancer in each core
          • PSA density <0.15ng/mL/g
          • T1 – T2a
          • Gleason score 2-6
          • PSA is less than 10 ng/ml
          • Clinical stage is T2b – T2c
            or
          • Gleason score is 7
            or
          • PSA is 10-20 ng/ml
          • Clinical stage is T3a
            or
          • Gleason score is 8 -10
            or
          • PSA is 20 ng/ml or above
          • T3b-T4
          • Primary Gleason pattern 5
            or
          • More than 4 cores with Gleason

          Metastatic disease: Any T, Any N, M1

          Once disease becomes M1 (metastatic) it progresses, despite therapy. The goals of treatment focus on slowing disease progression, improving quality of life and increasing survival time. Due to advances in research and development there are now newer therapies being made available, that have been shown to slow the progression of the metastatic prostate cancer, including Castration-Resistant Prostate Cancer (CRPC), and extend patient survival.

          What is Castration-Resistant Prostate Cancer (CRPC)?

          The majority of prostate cancer cells require the presence of testosterone hormones for stimulation of their growth. Castration is therefore one of treatment methods to control high risk, advanced or metastatic prostate cancer.

          Prostate cancer however, may contain cells that are initially insensitive or develop resistance to castration. With time these cells predominate and the cancer continues its growth despite the absence of testosterone. This stage of cancer growth is called castrate resistant.

          The term actually describes the fact that the prostate cancer is continuing to grow despite castrate levels of testosterone.

          Due to advances in research and development, there are now newer therapies being made available, that have been shown to slow the progression of the CRPC and extend patient survival.

          XX

           

          Donec eu risus quis nibh sodales. 

          Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam viverra lacus sed cursus vestibulum. Etiam nibh ex, dignissim ut erat sed, molestie vulputate purus. Nunc neque ligula, scelerisque at nulla eu, ullamcorper laoreet magna. Suspendisse interdum semper mi nec sodales. Duis vel placerat est. Aliquam lacinia, diam eu consectetur luctus, l

          Phone

          (234) 234-3467

          Location

          Building 6, Country Club Estate 21 Woodlands Drive, Woodmead, Johannesburg, 2191

          Email

          support@here4you.com

          Store Hours

          M-F: 8am – 5pm
          S-S: 9am – 4pm