What Are The Stages Of Prostate Cancer
If you are diagnosed with prostate cancer, the first thing your doctors will do is assess if and how much the cancer has spread. This process is called staging.
Prostate cancer, like all cancers, will fall into one of four stages. In stage 1, the cancer has not spread. The succeeding stages define gradually advanced stages of cancer up to stage 4, which describes cancer that has spread to other areas of the body.
Staging cancer is an important part of diagnosis and treatment. It helps doctors determine your treatment plan, and it helps patients understand how they will move forward.
Learning more about staging will help you understand what to expect from these early days of your diagnosis and make decisions regarding treatment.
Initial Treatment Of Prostate Cancer By Stage
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 treatment options. Risk groups range from very low risk to very high risk, with lower risk group cancers 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 taken into account 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.
Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
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The Staging Guide Video Series
Hi, I’m Dr. Scholz. Let’s talk about prostate cancer.
Today we’re going to talk about the five stages of prostate cancer. The PCRI has developed a system for patients. Prostate cancer is very complex. Who has time to study the full range of all the information associated with prostate cancer? Even the professionals have trouble keeping up. Patients need personalized information directed to their particular type of disease. This is what the PCRI’s Staging System provides.
There are a lot of different prostate cancer staging systems. All of these have been designed for physicians to help them decide on the correct treatment. The PCRI Staging System is designed for patients, simplified with a six question quiz. This is to enable patients to approach their physicians with accurate information about their disease, to raise the level of conversation with their physicians to a level that directs treatment to the specific type of therapy that patients need.
Thanks for watching. For more information subscribe to our channel or go to pcri.org.
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.
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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:
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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.
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.
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.
The Tnm System Of Staging
The TNM is a standard system of staging most cancers. It helps patients understand if or how far cancer has spread in their body and how advanced it may be when diagnosed. It uses ratings from stage 1 to stage 4 to describe how advanced your cancer is.
- T stands for the tumor and reflects its size and its extent.
- N stands for nodes. This tells us how many and which lymph nodes the cancer may have spread.
- M stands for metastasis. This indicates where and into what organs the cancer has spread.
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Stage 1 Of Prostate Cancer
If you are diagnosed with prostate cancer at stage 1, this means your cancer is small and hasnt spread beyond the prostate gland. It may mean the tumor cannot be seen, is slow growing, and involves only one side or less of the prostate.
This would be the same for all types of cancers and wherever the cancer begins. If it remains in the origin it would stage 1.
The good news is that stage 1 prostate cancer has a 5 year survival rate of 100%.
Stages Types And Grades
The tests and scans you have to diagnose your cancer will give some information about:
- the type of cell the cancer started in and where it began
- how abnormal the cells look under the microscope
- the size of the cancer and whether it has spread
In the UK, doctors use the Gleason system to grade prostate cancer. They might also talk about your Grade Group. This is a new grading system.
You might also be told about the TNM stage, or you may see this on your pathology report. Another way doctors may describe your cancer is as localised, locally advanced or advanced.
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Looking For More Survivorship Resources
For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:
ASCO Answers Cancer Survivorship Guide:Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.
Cancer.Net Patient Education Video:View a short video led by an ASCO expert that provides information about what comes after finishing treatment.
Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.
The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.
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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Prostate Biopsy Collaborative Group Risk Calculator
The Prostate Biopsy Collaborative Group Risk Calculator is similar in nature to the PCTP in that it looks at a variety of factors to determine candidacy for a biopsy. Thus, it can help to reduce unnecessary biopsies. However, this and the PCTP calculators have shown disparities in results across different race groups.
Prostate cancer treatment is approached with such consideration because the 5-year relative survival rate of all stages combined is high at 98%. Therefore, experts consider some treatment options unnecessary for survivability.
Stage : Prostate Cancer Involves More Of The Prostate And A Lump Is Detectable In An Exam
This category is divided into two stages: stage 2A and stage 2B.
In stage 2A, features are like stage 1, with these changes:
- PSA is at least 10, but less than 20.
- Gleason score is 6 but can be lower if diagnosis was by needle biopsy for conditions other than cancer.
- Cancer can be found in one half or less of the prostate lobe or more than one lobe.
Stage 2B cancer means that:
- The prostate cancer is more extensive, extending to opposite sides of the prostate. It might be detectable with a digital rectal exam. In this instance, the PSA lower than 20 and the Gleason score is 7, according to the National Cancer Institute.
- Alternatively, cancer remains undetectable in the digital rectal exam and imaging tests. PSA is lower than 20 and the Gleason score is 7.
- Yet another way this can manifest is with a Gleason score of 8 or more, PSA at any level, but imaging and DRE do not pinpoint the cancer.
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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.
The Stages Of Prostate Cancer: What You Need To Know
After a prostate cancer diagnosis, your oncologist will refer to the stage of your cancer. All cancers are categorized into four distinct stages, each of which identifies the progress of the growth of cancerous cells within clinically defined standards. These stages help doctors determine the most appropriate care for each patient based on his or her condition, and can also provide easy-to-understand context for your diagnosis. Learn more about the stages of prostate cancer, how each stage will affect your treatment plan and the survival rates for each stage, then contact Regional Cancer Care Associates to schedule a consultation.
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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.
Connect with a Top Mesothelioma Specialist
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Stage 3 Diagnostic Criteria
While we talk about stage 3 cancers as one monstrous thing, their diagnosis differs drastically based on cancer type. Generally, a stage 3 cancer diagnosis requires one or more of three features:
- Tumor growth beyond a specific size
- Spread to a specific set of nearby lymph nodes
- Extension of the tumor into nearby structures
Once diagnosed, a cancer stage never changes. Even if the doctor re-stages the cancer diagnosis, or it recurs , they keep the initial staging diagnosis.
The doctor will add the new staging diagnosis to the initial stage and differentiate it with letterslike c for clinical, p for pathological , or after treatments .
Some stage 3 cancers are subdivided to give a more precise classification. These sub-stages will differ based on the specific cancerous organ. For example, stage 3 breast cancer has three subcategories:
- The tumor is smaller than 5 centimeters but has spread to 4-9 nodes.
- The tumor is larger than 5 cm and has spread to 1 to 9 nodes.
3B: The tumor is any size but has invaded the chest wall or breast skin and is swollen, inflamed, or has ulcers. It may have also invaded up to 9 nearby nodes
3C: The tumor can be any size but has spread to either: 10 or more lymph nodes, nodes near the collar bones, or lymph nodes near the underarm and the breast bone
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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.