More Detail On Prostate Cancer Staging
The standard Tumor, Node, and Metastasis system is used to stage prostate cancer. The T category is based on the extent of the tumor itself. The N category is based on whether the cancer has spread to nearby lymph nodes. The M category is based on whether the cancer has spread beyond nearby lymph nodes to distant organs.
- T1: the tumor cannot be felt with a DRE or seen with imaging
- T1a: the tumor is found accidentally during a surgery for benign prostatic hyperplasia or another prostate condition. The tumor takes up less than 5% of the removed tissue
- T1b: the tumor is found accidentally during a surgery, and the tumor takes up more than 5% of the removed tissue
- T1c: the tumor is diagnosed with a needle biopsy, usually because of an elevated PSA
Each of the stages is based on some combination of these categories.
What Have Randomized Trials Of Prostate Cancer Screening Found
Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .
The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :
What Does It Mean If In Addition To Cancer My Biopsy Report Also Says Acute Inflammation Or Chronic Inflammation
Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on a biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase you PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with cancer does not affect their prognosis or the way the cancer is treated.
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The Sum Of Two Numbers
The pathologist assigns two separate grades to the two predominant cancer cell patterns in the prostate tissue sample. They determine the first number by observing the area where the prostate cancer cells are most prominent. The second number, or secondary grade, relates to the area where the cells are almost as prominent.
These two numbers added together produce the total Gleason score, which is a number between 2 and 10. A higher score means the cancer is more likely to spread.
When you discuss your Gleason score with your doctor, ask about both the primary and secondary grade numbers. A Gleason score of 7 can be derived from differing primary and secondary grades, for example 3 and 4, or 4 and 3. This can be significant because a primary grade of 3 indicates that the predominant cancer area is less aggressive than the secondary area. The reverse is true if the score results from a primary grade of 4 and secondary grade of 3.
Text Mining Algorithm Evaluation
A confusion matrix was used to compare the text mining algorithm extracted against the manually coded values . The confusion matrix consists of four values: True Positives : correctly extracting the GS, True Negatives : correctly extracting a biopsy without a GS, False Positive : falsely extracting a GS and False Negative : falsely extracting the manually coded GS . The precision and recall are calculated using these four values as follows: \ and \ respectively. Precision and recall are similar to positive predictive value and sensitivity respectively. The F-score is the harmonic mean of precision and recall and is calculated using the formula \. The manually coded values were assumed to be the gold standard, i.e. exact match. Therefore, we reported the data as Exact Match: Yes and Exact Match: No for both the predicted and manually coded values.
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What Is A Normal Gleason Score For Prostate Cancer
Your Gleason score doesn’t rank potential ranges like ranges set for elevated PSA tests. Instead, providers break Gleason scores into three categories:
- Gleason 6 or lower: The cells look similar to healthy cells, which is called well differentiated.
- Gleason 7: The cells look somewhat similar to healthy cells, which is called moderately differentiated.
- Gleason 8, 9 or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.
What are grade groups?
Healthcare providers established grade groups to clarify the Gleason score system. Those grade groups are:
- Grade Group 1 = Gleason 6 .
- Grade Group 2 = Gleason 3+4=7.
- Grade Group 3 = Gleason 4+3=7.
- Grade Group 4 = Gleason 8.
- Grade Group 5 = Gleason 9-10.
How Is The Gleason Score Derived
The pathologist looking at the biopsy sample will assign one Gleason grade to the most predominant pattern in your biopsy and a second Gleason grade to the second most predominant pattern. For example: 3 + 4. The two grades will then be added together to determine your Gleason score. Theoretically, Gleason scores range from 2-10. However, since Dr. Gleasons original classification, pathologists almost never assign scores 2-5, and Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer.
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How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.
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
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What Does Gleason 6 Mean
A Gleason score of 6 is different from other prostate cancer diagnoses because it means all the biopsy samples are grade 3 . Though the samples dont look like normal tissue, no grade 4 or 5 samples were found.
Gleason 6 prostate tumors are:
- Confined to the prostate
- Not causing any symptoms
There are changes at the cellular level, but the prostate cancer is likely slow-growing and has a low-risk of metastasizing, or spreading to other areas of the body.
This knowledge allows your doctor to monitor you and see how your tumor changes over time.
What Are The Damico Risk Categories
The DAmico system provides an estimate of the risk of recurrence at five years after treatment. This system is one of the most widely used for risk assessment. It combines the PSA, Gleason score, and the clinical stage to create low, intermediate, and high risk categories. The higher the risk category, the higher the chance of recurrence is five years after treatment.
The DAmico risk categories are below. If one factor is putting you in a lower category but another is putting you in a higher category, then the higher category takes precedent.
- PSA is less than 10 ng/mL AND
- Gleason score is equal to or less than 6 AND
- Clinical stage T1-T2a
- PSA is between 10 and 20 ng/mL OR
- Gleason score is 7 OR
- Clinical stage T2b
- Gleason score is 8-10 OR
- PSA is greater than 20 ng/mL OR
- Clinical stage T2c-T3
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Survival Rates For Prostate Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
What Is Cancer Grading
After a biopsy is taken and prostate cancer is diagnosed, the grade of your cancer will be determined. This is done by examining the cancer cells under a microscope to decide how abnormal the cancer cells are. The more abnormal they are, the more likely the cancer is to be aggressive or to spread quickly outside of the prostate.
The grade of your cancer is an important piece of information for your physicians to have when deciding upon the proper treatment. The most common scale for prostate cancer grading is the Gleason score.
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Monitoring And Treatment Decisions
In the past, men with prostate cancerregardless of whether it was aggressive or notwere almost always treated right away with a targeted therapy like surgery or radiation. However, in recent years, experts have revisited this one-size-fits-all approach to prostate cancer.
Experts now understand that low-risk prostate cancerlike Gleason 6 tumorsmay not need treatment right away. In fact, major medical associations, including the American Urological Association and the Society for Urologic Oncology, now recommend the use of active surveillance for low-risk prostate cancer.
What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia
All of these are terms for things the pathologist might see under the microscope that are benign , but that sometimes can look like cancer.
Atrophy is a term used to describe shrinkage of prostate tissue . When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy. Focal atrophy can sometimes look like prostate cancer under the microscope.
Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy.
Finding any of these is not important if prostate cancer is also present.
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Recent Advances: Molecular Markers
Currently, risk stratification for men who have recently been diagnosed with prostate cancer by biopsy is accomplished with the combination of prostate-specific antigen level, clinical stage, and Gleason score or Grade Group. The limitation of using these parameters for risk stratification is that collectively they do not address specific biologic features of prostate cancer, specifically the aggressiveness of tumor cells. In addition, many studies have shown that localized prostate malignancy can vary in potential for progression in different patients, despite similar risk-stratifying characteristics.
This problem has sparked the advent of research and use of biological/genomic assays to help risk stratify men diagnosed with localized prostate cancer. The theory behind utilizing genomic assays is to identify genes in biopsy specimens that potentiate cellular proliferation.
Cooperberg et al aimed to validate the application of the cell cycle progression score in identifying men at risk for recurrent disease after radical prostatectomy. The CCP score identifies genes that promote cellular proliferation. In this study, the CCP score was compared with the Cancer of the Prostate Risk Assessment post-Surgical , which risk stratifies recurrence after prostatectomy based on pre-procedural PSA, Gleason score, and clinical staging, and has been shown to have good accuracy.
- Confirm MDx
- Oncotype DX
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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What Is The Gleason Grading System
Your Gleason score isn’t a separate test. It’s a number based on the results of your biopsy. You usually get it when you’re first diagnosed with prostate cancer.
The doctor 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 cells look 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.
The two grades added together are your Gleason score. Cancers will score 6 or more. A score of 7 means the cancer is intermediate, and a higher score means the cancer is more likely to grow and spread.
Your doctor will use this combined score along with the results of your PSA blood test and digital rectal exam to see how advanced your prostate cancer is. They’ll use this information to suggest the best treatment for you.
Very Scared: Gleason 9 Prostate Cancer
I saw my specialist last week and he informed me that I had level 9 Gleason prostate cancer. I am awaiting a CT scan and then a bone scan. I am in no pain whatsoever at the moment and I consider myself quite fit playing golf 4 times a week and walking with my wife and dog the other days. I am 60 years old and am quite scared for my future. I am not scared of the pain, just not being around for my wife and 2 grown up children.
Can anyone give me hope for optimism as all I have seen about level 9 gleason is not great.
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What Is Prostate Cancer
Prostate cancer develops in the prostate a small gland that makes seminal fluid. It is one of the most common types of cancer in men. Prostate cancer usually grows over time and in the beginning usually stays within the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
Prostate cancer that is caught early has a better chance of successful treatment.
Stages Of Prostate Cancer
Any T, any N, M1
Any Grade Group
The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.
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.
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