What Is Stage 9 Prostate Cancer

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.

Treatment For Prostate Cancer At Moffitt Cancer Center

When a patient turns to Moffitt Cancer Center for diagnosis or treatment, we provide them with an individualized treatment plan that a multispecialty team of experts carefully assembles based on a comprehensive range of factors. We understand that prostate cancer stages are just a small part of the big picture our oncologists evaluate everything from the stage and cellular makeup of the cancer to the patients overall health and personal preferences, and then tailor a treatment plan to fit the patients unique situation.

Medically reviewed by Monica Chatwal, MD.

No referral is required to come to Moffitt. You can request an appointment online or call , and well set up a time for you to meet with one of our oncologists specializing in prostate cancer.

The Tnm System For Prostate Cancer Stages

As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:

• Tumor. Whatâs the size of the main area of prostate cancer?
• Nodes. Has it spread to any lymph nodes? If so, how far and how many?
• Metastasis. How far has the prostate cancer spread?

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What Are Prostate Cancer Survival Rates By Stage

Staging evaluation is essential for the planning of treatment for prostate cancer.

• A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
• Further testing and calculations may be performed to best estimate a patient’s prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patient’s life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from analysis of many patients’ treatment results.

The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancer’s responsiveness to treatment, among other factors.

Effects Of Gp On Prognosis In The After

To compare the prognosis between the GP 4 + 5 and the GP 5 + 4 groups in the absence of effects from other covariates, a 1:1 ratio of the PSM process was performed to generate a cohort of 5,130 patients. The baseline characteristics were well-balanced . In the matched groups, the GP 5 + 4 group had a poorer OS than the GP 4 + 5 group . The GP 5 + 4 group was also associated with a higher cumulative incidence of CSM compared with the GP 4 + 5 group .

Table 2. Univariate and multivariate Cox analyses of OS .

Table 3. Univariate and multivariate analysis for CSS using the competing risk model .

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Stage 1 Prostate Cancer

Stage 1 is the least advanced form of prostate cancer. Cancer in this stage is small and hasnt spread past the prostate gland. Its characterized by a PSA of less than 10 ng/mL, a grade group score of 1, and a Gleason score of 6.

Stage 1 prostate cancer has a 5-year survival rate of nearly 100 percent.

What Do My Test Results Mean

Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.

How far has my cancer spread?

The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.

Depending on the results, your cancer may be treated as:

• localised prostate cancer it’s contained inside the prostate
• locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
• advanced prostate cancer its spread from the prostate to other parts of the body.

Is my cancer likely to spread?

Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.

Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.

To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer.

Low risk

Your cancer may be low risk if:

• your PSA level is less than 10 ng/ml, and
• your Gleason score is 6 or less , and
• the stage of your cancer is T1 to T2a.

Medium risk

Your cancer may be medium risk if:

• your PSA level is between 10 and 20 ng/ml, or
• your Gleason score is 7 , or
• the stage of your cancer is T2b.

High risk

What happens next?

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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.

Managing Bone Pain And Weakness

Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.

Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.

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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

Results Of Oncological Treatment

shows the KaplanMeier curves for carcinoma-specific survival in patients with tumor stage pT3a, pT3b, pT4, pN1 and/or preoperative PSA > 20 ng/mL and/or prostatectomy Gleason score 8.

Prostate carcinoma-specific survival after radical prostatectomy for patients with confirmed locally advanced tumors and/or confirmed lymph-node metastases and/or preoperative PSA > 20 ng/mL and or Gleason score 8 in the prostatectomy specimen. The dotted lines show the 95% confidence interval. a) Prostate carcinoma-specific survival, stratified according to pT stage. b) Prostate carcinoma-specific survival in patients with lymph-node metastases. c) Prostate carcinoma-specific survival in patients with preoperative PSA > 20 ng/mL. d) Prostate carcinoma-specific survival in patients with prostatectomy Gleason score 8.

The 10-year carcinoma-specific survival rates were:

• 98% for patients with stage pT3a

• 87% for patients with stage pT3b

• 77% for patients with stage pT4

• 81% for patients with confirmed lymph-node metastases

Among patients with a high-risk tumor constellation, the 10-year carcinoma-specific and 10-year overall survival rates were 93% and 85% respectively for those with a preoperative PSA level > 20 ng/mL and 70% and 58% for those with a prostatectomy Gleason score 8 . The corresponding 10-year biochemically recurrence-free survival rates were 32% and 25%.

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Whats The Difference Between Cancer Grading And Staging

If your healthcare provider suspects prostate cancer, he or she will refer you for a prostate biopsy. During this procedure, a small sample of prostate cells from the tumor is removed and evaluated under the microscope. This microscopic examination is what gives a cancer its grade. Cancer grade refers to how quickly it may grow or spread . For the most part, the lower the grade, the slower the growth of the tumor.

In addition to finding out the grade of your prostate cancer, it is important to determine its stage. Cancer stage refers to the size of the tumor and whether or not it has spread to other parts of the body. Stages mean different things for different types of cancer, but usually the higher the number, the more advanced the cancer.

The Prostate Cancer Grading System

Prostate cancer grading is based on the appearance of the tumor cells under the microscope. Low-grade cancer cells look more like healthy cells than do high-grade cells. The two methods used to measure prostate cancer grade are the Gleason score or Grade Group.

While examining the tumor cells, the pathologist looks at the two most common tumor cell patterns referred to as the primary and secondary patterns. Each of these patterns is then graded based on how closely they resemble normal prostate tissue.

Grade 1 cells look like normal prostate cells. Grade 5 cells are very abnormal appearing cells. Grades 2-4 are in between the higher the number, the less the cells look like normal prostate tissue. Almost all prostate cancer has grade 3 cells or higher. Once the pathologist has assigned a grade to the primary and secondary cell patterns, these two numbers are added together to get a total Gleason score. The higher the Gleason score, the more likely the tumor is going to grow or spread to other parts of the body. Since the lowest grade a cancer cell can have is grade 3 , the lowest Gleason score for a cancer is grade 6 and is considered low-grade prostate cancer.

Using the Gleason score, prostate cancers can be divided into three groups:

ISUP Prostate Cancer Grade Groups:

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How Is Prostate Cancer Staged

Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.

The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.

The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.

• Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
• The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
• Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.

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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Grade And Risk Category

The biopsy results will show the grade of the cancer. This is a score that describes how quickly the cancer may grow or spread.

For many years, the Gleason scoring system has been used to grade the tissue taken during a biopsy. If you have prostate cancer, youll have a Gleason score between 6 and 10. A new system has been introduced to replace the Gleason system. Known as the International Society of Urological Pathologists Grade Group system, this grades prostate cancer from 1 to 5 .

Risk of progression

Based on the stage, grade and your PSA level before the biopsy, localised prostate cancer will be classified as having a low, intermediate or high risk of growing and spreading. This is known as the risk of progression. The risk category helps guide management and treatment.

Grading prostate cancer

What Does Staging And Grading Mean For Treatment

These two numbers are the most important for determining your future course of treatment. Some treatments are only effective for Stages I and II, where the cancer is still confined to the prostate. Some other treatments only become necessary at Stages III and IV, where the cancer has spread outside the prostate.

Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with treatment. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance and avoid side effects.

In any case, the stage and grade should be a vital component of any discussion with your doctor.

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What Happens When Prostate Cancer Is Left Untreated

Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.

While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their doctors monitor their cancer.

Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, doctors will initiate cancer treatment only if cancer starts growing.

Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.

This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your doctor and family.

What Is A Gleason Score

Cancer cells donât look the same as healthy cells. The more different they appear, the more aggressive the cancer tends to be.

The Gleason system uses the numbers 1 to 5 to grade the most common and second most common patterns of cells found in a tissue sample.

• Grade 1: The tissue looks very much like normal prostate cells.
• Grades 2-4: Cells that score lower look closest to normal and represent a less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
• Grade 5: Most cells look very different from normal.

Doctors add your primary and secondary numbers together to form your total Gleason score. That tells you how aggressive the cancer is. The lowest score for a cancer 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.

Generally speaking, the higher your Gleason score, the more aggressive the cancer. That means itâs more likely to grow and spread to other parts of your body. Doctors use this information, along with the stage of the cancer, to choose the best treatment for you.

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What Does It Mean To Have A Gleason Score Of 6 Or 7 Or 8

The lowest Gleason Score of a cancer found on a prostate biopsy is 6. These cancers may be called well-differentiated or low-grade and are likely to be less aggressive – they tend to grow and spread slowly.

Cancers with Gleason Scores of 8 to 10 may be called poorly differentiated or high grade. These cancers tend to be aggressive, meaning they are likely to grow and spread more quickly.

Cancers with a Gleason Score of 7 may be called moderately differentiated or intermediate grade. The rate at which they grow and spread tends to be in between the other 2.