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
Tnm Staging: More Precise And More Complicated
A more involved but precise staging method is endorsed by the American Joint Committee on Cancer. The precision of this system helps doctors select patients for research and treatment on the basis of the biology of the cancer.
TNM stages categorize
- The size of the tumor
- The involvement of lymph nodes
- Metastasis and cancer grade.
The system is a bit complicated and is thoroughly described in public information provided by the ACS.
What Is The First Sign Of Cancer
Cancer symptoms can vary significantly for each person. However, there are a few things that could indicate the early signs of disease. Schedule an appointment with your healthcare provider if you experience:
- Unexplained weight loss.
- Dysphagia .
- A mole or wart that changes in appearance.
Please note that these symptoms do not mean that you definitely have cancer. However, if any of these symptoms appear, you should see your healthcare provider right away.
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What You Can Do
Its important that you learn all you can about advanced prostate cancer so you can make informed decisions. Be open with your doctors and others on your healthcare team. Express your concerns and feel free to advocate for yourself and your quality of life. Get another medical opinion if you feel its necessary.
Some complementary therapies may prove helpful in coping with advanced cancer. For example:
- tai chi, yoga, or other movement therapy
- music therapy
- meditation, breathing exercises, or other relaxation techniques
A variety of services can help you with everything from lodging while youre getting treatment to getting some help around the house. Communicating with online or in-person groups are a good way to share information and lend mutual support.
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.
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What Are The Possible Treatment Options For Prostate Cancer
Staging is not the only information that doctors need. Symptoms and the patients age, life expectancy, co-existing health conditions and personal preferences may also be considered when deciding on treatment. Doctors use a general guideline for treatment based on stage groups.
Stage I prostate cancer:
Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
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What Does It Mean For Prostate Cancer To Spread
Cancer cells can spread to other parts of the body. Doctors say the cancer has âmetastasizedâ or spread if this occurs.
Prostate cancer can spread to:
- pale skin due to anemia
These symptoms can also occur with aging and an enlarged prostate. As a result, some people may ignore them instead of seeking medical attention.
According to the Prostate Cancer Foundation, age is the biggest contributing factor to prostate cancer risk. Doctors diagnose an estimated 60% of all prostate cancers in males older than 65 years of age.
It states that additional risk factors for prostate cancer include:
- Family history: People with a close relative who has had prostate cancer may be twice as likely to get prostate cancer as those who do not.
- Race: Males of African descent are about 75% more likely to develop prostate cancer than white males and more than twice as likely to die from the condition.
- Smoking: A history of smoking is associated with a higher risk of aggressive prostate cancer.
Types Of Prostate Cancer
The type of prostate cancer tells you which type of cell the cancer started in. There are different types of prostate cancer. The most common type is adenocarcinoma of the prostate.
Doctors use the information about your prostate cancer type along with:
- how abnormal the cancer cells look under the microscope. This is the grade of the cancer
- the size of the cancer and whether it has spread. This is the stage
This helps your doctor decide which treatment you need. Another way doctors may describe your cancer is as localised, locally advanced or advanced.
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Biomarkers Or Tumor Markers
Biomarkers are substances found in high levels in cancer patients. These tumor markers may be found in blood, urine, body tissues or tumors, and they may influence staging with some cancers. One example is that men with prostate cancer have high levels of the prostate-specific antigen . For some cancers, these markers may be more useful than facts garnered from other staging factors when deciding treatment.
Some tests may indicate whether tumor cells have certain chemical receptors shown to respond to certain treatments, such as drugs that target those receptors or the substances to which they attach. Breast cancer patients may be tested to determine whether cancer cells have receptors for the hormones estrogen and progesterone. The genetics of the tumor may help the care team determine which treatments to recommend. Researchers have discovered many genes involved in various cancers, and drugs have been developed to specifically target many of these cancers.
How Is Prostate Cancer Diagnosed
Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients.
Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds.
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What Percentage Of Men With Prostate Cancer Show Early Urinary Symptoms
Less than five percent of men with prostate cancer show early urinary symptoms. The condition has usually progressed to later stages when prostate cancer symptoms do arise. Some men may experience symptoms that can indicate the presence of prostate cancer.
What does prostate cancer urine look like?
But in the case of prostate cancer, it usually occurs in advanced stages of the disease and it should not be ignored. Instead of the normal pale yellow color of the urine, men may note it is pink, red, brownish-red, or tea-colored.
What Can I Expect If I Have Cancer
Hearing that you have cancer can be scary, saddening and even frustrating. Its important to be frank with your healthcare provider about how youre feeling. Finding a support group can also help you cope while youre on your journey. Cancer treatment options vary, so talk to your healthcare provider about what to expect.
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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.
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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Stage Ii Prostate Cancer
The tumor is more advanced or a higher grade than Stage I, but the tumor doesnt extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.
Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated.
- Stage IIB: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated.
- Stage IIC: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.
Stage Iii Prostate Cancer
The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells havent spread to the lymph nodes.
Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.
- Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.
- Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.
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After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose prostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
What Is Advanced Prostate Cancer
Prostate cancer is cancer that starts in the prostate gland. Advanced prostate cancer occurs when it has spread, or metastasized, from the prostate to other areas of the body.
Cancer spreads when cells break off from the original tumor and invade nearby tissue. This is called localized metastasis. Cancer can spread directly into nearby tissues or through the lymphatic system to distant parts of the body. When this happens, its called metastatic disease or prostate cancer with metastasis to a certain body part or organ system.
New tumors can grow in any organ, but prostate cancer is most likely to spread to the:
- adrenal gland
Stage 4 prostate cancer occurs when the prostate cancer has already spread to distant organs or tissues at the time of diagnosis. Most of the time, doctors diagnose prostate cancer at an earlier stage. Its generally a slow-growing cancer, but it can spread or it can come back, or recur, after treatment.
When cancer is confined to the prostate, many men have no symptoms. Others have trouble urinating or notice blood in their urine.
Metastatic cancer can cause generalized symptoms such as:
- weight loss
Other symptoms of advanced prostate cancer depend on where it has spread and how big the tumors are:
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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:
|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.
The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
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