Prostate Cancer Staging And Grading

Prostate Cancer Risk Factors

Throughout this article, the prostate biopsy was highlighted as an essential step in diagnosing prostate cancer. But the prostate biopsy is only performed after the screening of a suspicious case, and screening is only performed in patients with a high risk.

The most important risk factors include :

• Age: As we age, the risk of prostatic carcinoma increases. It is one of the most common types of cancer in aging males. 80% of cases are diagnosed in men after 65 years of age.
• Family history: Prostate cancer has a genetic link. If you have close male relatives with prostate cancer, you have a higher chance of having the same problem.
• Race: Males of African American descendancy have a higher rate of prostate cancer. They may also have a higher rate of aggressiveness.

Understanding Staging Grading Castration

Medically reviewed in December 2022

Prostate cancer refers to any cancer that begins in the prostate gland. However, as with most types of cancer, there are different subtypes of prostate cancer. There is also a somewhat complex staging system and other information to unpackGleason scores, PSA levels, terms like hormone-sensitive and castration-resistant.

For a person with prostate cancer and their loved ones, this is a lot of information to take inespecially in the wake of receiving a cancer diagnosis or learning that prostate cancer has spread.

In order to make the best decisions you can about your treatment, youll want to know everything you can about the cancer that you are up against. A good understanding of your prostate cancer diagnosis requires a good understanding of the basics of prostate cancer.

With that in mind, here are simple explanations of key terms related to prostate cancer.

Keep in mind that these are simplified explanations, intended to be used as a starting point to better understand a prostate cancer diagnosis. When it comes to information about cancerand especially your diagnosisthere is no substitute for the information that comes from your healthcare providers. Likewise, your healthcare providers will be the best people to ask if you have a question about your diagnosis.

What Is Prostate Cancer

Prostate cancer is the most common non-skin cancer affecting men in the United States. It is estimated that 11% of men will be diagnosed with prostate cancer at some point in their lives and 2.5% will die from it .

The prostate gland is about the size of a walnut, and sits at the base of the bladder in front of the rectum. Its main job is to make prostatic fluid that helps keep your sperm healthy.

In prostate cancer, abnormal cells begin slowly growing in the peripheral zone of the prostate gland . If undetected, cancer may grow and spread beyond the prostate gland via three potential routes:

• Growing into adjacent tissues
• Spreading through the lymph nodes into the lymph system
• Traveling in the bloodstream to distant tissues, like bone, lung or liver

If your healthcare provider suspects prostate cancer, you will need a prostate biopsy. During this procedure, a small sample of prostate cells from the tumor is removed and evaluated under a microscope. This biopsy, along with other tests like ultrasound, CT, MRI, etc. will help establish the grade and stage of your cancer to determine the best course of treatment.

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Stages Of Prostate Cancer

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.

Stage 1 Prostate Cancer

Stage 1 is early-stage prostate cancer and means that the cancer is small, only in the prostate, and contains low grade cancer cells. Its also called localized prostate cancer. By the TNM system, it is T1 , N0, M0 and the Gleason group grade 1. Typically, it will have a PSA level of less than 10 ng/ml .

According to the American Cancer Society, the survival rate of localized prostate cancer is excellent, with almost 100% of people still alive five years after their diagnosis .

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Genetic Testing For Some Men With Prostate Cancer

Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.

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What Is Advanced Prostate Cancer

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.

• Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
• Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
• Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.

When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.

There are several types of advanced prostate cancer, including:

Biochemical Recurrence

With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.

Castration-Resistant Prostate Cancer

Non-Metastatic Castration-Resistant Prostate Cancer

Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.

Metastatic Prostate Cancer

• Lymph nodes outside the pelvis
• Other organs, such as liver or lungs

Metastatic Hormone-Sensitive Prostate Cancer

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

• A PSA test every 3 to 6 months

• A DRE at least once every year

• Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

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 hasnt spread.

It cant 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:

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Initial Treatment Of Prostate Cancer By Stage And Risk Group

The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.

For prostate cancers that haven’t spread , doctors also use risk groups to help determine if more tests should be done and to help guide treatment options. Risk groups range from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups.

Other factors, such as your age, overall health, life expectancy, and personal preferences are also important when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.

You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here. Taking part in a clinical trial of newer treatments is also an option for many men with prostate cancer.

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Characteristics Of Prostate Cancer

Ninety-five percent of prostate cancers are adenocarcinomas. In approximately 4% of men with prostate cancer, the neoplasm has transitional cell morphology and is thought to arise from the urothelial lining of the prostatic urethra.

In rare cases, the tumor has a neuroendocrine morphology in such instances the neoplasm is believed to have arisen from the neuroendocrine stem cells that are normally present in the prostate or from aberrant differentiation programs during cell transformation.

Seventy percent of prostate cancers arise in the peripheral zone, 15-20% arise in the central zone, and 10-15% arise in the transition zone.

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Prostate Cancer: Stages Grades And Treatment

Cancer stage refers to the size of the tumor and whether or not it has spread to other parts of the body prostate cancer is staged using the TNM system. Cancer grade refers to how quickly the cancer cells will grow and spread prostate cancer is graded using the Gleason score. Treatment of prostate cancer is based on a combination of age, life expectancy, and personal preferences, in addition to cancer grade and stage. In general, the higher the grade or stage, the more likely it is that the cancer will spread.

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:

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.

Prostate Health Index Testing

The Prostate Health Index test is a diagnostic blood test that combines free and total PSA and the pro-PSA isoform . The PHI test is intended to reduce the number of unnecessary prostate biopsies in PSA-tested men. In prospective multicenter studies, the PHI test has outperformed free and total PSA for detection of prostate cancer and has improved prediction of clinically significant prostate cancer in men with a PSA of 2 or 4 ng/mL to 10 ng/mL.

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Prostate Cancer Grading & Prognostic Scoring

The Gleason Score is the grading system used to determine the aggressiveness of prostate cancer. This grading system can be used to choose appropriate treatment options. The Gleason Score ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue or abnormal tissue . Most cancers score a grade of 3 or higher.

Since prostate tumors are often made up of cancerous cells that have different grades, two grades are assigned for each patient. A primary grade is given to describe the cells that make up the largest area of the tumor and a secondary grade is given to describe the cells of the next largest area. For instance, if the Gleason Score is written as 3+4=7, it means most of the tumor is grade 3 and the next largest section of the tumor is grade 4, together they make up the total Gleason Score. If the cancer is almost entirely made up of cells with the same score, the grade for that area is counted twice to calculated the total Gleason Score. Typical Gleason Scores range from 6-10. The higher the Gleason Score, the more likely that the cancer will grow and spread quickly.

What Is Survivorship

The word survivorship means different things to different people. Common definitions include:

• Having no signs of cancer after finishing treatment.

• Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

Survivorship can be a complicated part of having cancer. This is because it is different for everyone.

For some, even the term survivorship does not feel right, and they prefer to use different language to describe and define their experience. Sometimes extended treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety will still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

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What Does It Mean

A Gleason score of 6 is low grade, 7 is intermediate grade, and a score of 8 to 10 is high grade cancer.

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Its also important to know whether any cells rated at Gleason grade 5 are present, even in just a small amount, and most pathologists will report this. Having any Gleason grade 5 in your biopsy or prostate puts you at a higher risk of recurrence.

But because many prostate cancer cases are extremely slow-growing, the Gleason system didnt necessarily do a good job of communicating the risks for these cases. Patients with scores of 6 and 7 didnt have a clear picture of the nature of their particular cancer.

Understanding Prostate Cancer: The Gleason Scale

Knowing the numbers

If you or a loved one has been diagnosed with prostate cancer, you may already be familiar with the Gleason scale. It was developed by physician Donald Gleason in the 1960s. It provides a score that helps predict the aggressiveness of prostate cancer.

A pathologist begins by examining tissue samples from a prostate biopsy under a microscope. To determine the Gleason score, the pathologist compares the cancer tissue pattern with normal tissue.

According to the

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