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Even with early detection, there is no proof that finding and treating asymptomatic prostate cancers do more good than
harm. The reason: Many prostate cancers found through screening are slow-growing and might never cause symptoms. So far, it has not been possible to
distinguish these slow-growing tumors from tumors that are aggressive and deadly.
About Staging
A diagnosis of prostate cancer obviously presents a man with complex decision. He needs to understand the ramifications of
the various options available to him. There are several levels, or stages, of prostate cancer, all of which call for different approaches to
treatment. Moreover, for some stages of prostate cancer, there are several types of treatment, and it is not always clear which one is best. In fact,
because treatment can produce some serious and life-long side effects--and because prostate cancer may grow very slowly--treatment may not always be
better than no treatment.
If the prostate biopsy finds a cancer, more tests are performed to find out whether the cancer has spread and if so, how
far. This process is called staging. Staging is very important because your treatment and the outlook for your recovery depend on the stage of your
cancer.
There is more than one system for staging prostate cancer. The TNM system is used most often and gives three key pieces of
information:
T refers to the Tumor. There are actually two types of T classifications
for prostate cancer. The clinical stage is based on digital rectal exam, needle biopsy and transrectal ultrasound findings. The pathologic
stage is based on what the doctor finds when the entire prostate gland, both seminal vesicles and, in some cases, nearby lymph nodes are removed and
examined.
N describes how far the cancer has spread to nearby lymph Nodes.
M shows whether the cancer has spread (Metastasized) to other organs of
the body.
Knowing the clinical stage is important because it can help in
making treatment decisions, such as whether a man might benefit from having the prostate removed. But the clinical stage might not show how much the
cancer has spread. The pathologic stage, determined after surgery, is more useful in predicting the outlook for survival. Men who don't have surgery, of
course, don't have a pathologic T stage determination.
Letters or numbers after the T, N, and M give more details about each of these factors. To make this information somewhat
clearer, the TNM descriptions can be grouped together into a simpler set of stages, labeled stage 0 through stage IV (0-4).
In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), indicates a
more serious cancer.
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to
explain your stage in a way you can understand. This will help you both decide on the best treatment for you.
About Grading
Some prostate cancers grow slowly while others grow more quickly. Cells taken during your biopsy are studied in the lab to
help decide how fast your tumor is growing. This process is called grading. A fast growing tumor is called aggressive. The Gleason system
is used most often for grading. Under this system a lower number such as 2-4 indicates a slower growing tumor. A higher number such as 8-10 means the
cancer cells are likely to grow more quickly. Scores of 5-7 are considered "in between." Ask your doctor to explain the grade of your tumor
because it is another important factor in making treatment decisions.
Prostate
Cancer Stages
T Stages (Tumor)
T1
The tumor cannot be felt or seen with imaging such as transrectal ultrasound.
T1a
The cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement and is present in less than 5 percent of the
tissue removed.
T1b
The cancer is found through TURP and is present in more than 5 percent of the tissue removed.
T1c
The cancer is found by needle biopsy done because of an elevated PSA level.
T2
The cancer can be felt through a digital rectal exam (DRE).
T2a
The cancer is in one side of the prostate.
T2b
The cancer is in both sides of the prostate.
T3
The cancer has begun to spread outside the prostate and may involve the seminal vesicles.
T3a
The cancer extends outside the prostate but not to the seminal vesicles.
T3b
The cancer has spread to the seminal vesicles.
T4
The cancer has spread to tissues next to the prostate (other than the seminal vesicles), such as the bladder's external sphincter (muscles that help
control urination), the rectum and/or the wall of the pelvis.
N Stages (Lymph nodes)
N0
The cancer has not spread to any lymph nodes.
N1
The cancer has spread to one or more regional (nearby) lymph nodes in the pelvis.
M stages (Metastasis)
M0
The cancer has not spread beyond the regional nodes.
M1
The cancer has spread to distant (outside of the pelvis) lymph nodes, bones or other organs such as the lungs, liver or brain.
Stage Groupings for Prostate
Cancer
Once a patient's T, N and M categories have been determined, they are then combined into a "stage group" and assigned a
stage number, expressed in Roman numerals from I (the least advanced) to IV (the most advanced). This "code" is used to determine your outlook
for survival or cure.
Stage I
T1a, N0, M0, low grade or score
Description
The cancer is confined to the prostate and has not spread to lymph nodes or elsewhere in the body. It can be detected through a transurethral
resection (TURP) and has a very low Gleason score. The cancer is found in less than 5 percent of the tissue in the prostate.
Treatment
For cancers limited to the prostate, treatment options include watchful waiting, surgery or radiation therapy. Surgery or radiation therapy is
typically chosen by men whose tumors, although apparently localized, are more extensive or poorly differentiated (with a Gleason score of eight to 10).
Without aggressive therapy, approximately three-quarters of these men will develop metastatic cancer in the following 10 years. Watchful waiting is
often chosen by older men whose tumors are small and slow-growing.
Prognosis
Stage I prostate cancers have a 90 percent disease-specific survival rate, regardless of the treatment type chosen. There are ongoing trials to
determine if men who choose watchful waiting run a greater risk of the cancer eventually metastasizing.
Stage II
T1a, N0, M0, intermediate or high grade or score
T1b, N0, M0, any grade or score
T1c, N0, M0, any grade or score
T1, N0, M0, any grade or score
T2, N0, M0, any grade or score
Description
The cancer has not spread to the lymph nodes or elsewhere in the body. The tumor can be found through a rectal exam, a high PSA level, a high
Gleason score, a biopsy or TURP. It involves more than 5 percent of the tissue within the prostate.
Treatment
For cancers limited to the prostate, treatment options include watchful waiting, surgery or radiation therapy. Surgery or radiation therapy is
typically chosen by men whose tumors, although apparently localized, are more extensive or poorly differentiated (with a Gleason score of eight to 10).
Without aggressive therapy, approximately three-quarters of these men will develop metastatic cancer in the following 10 years. Watchful waiting is
often chosen by older men whose tumors are small and slow-growing.
Prognosis
Stage II prostate cancers have a 90 percent disease-specific survival rate, regardless of the treatment type chosen. There are ongoing trials to
determine if men who choose watchful waiting run a greater risk of the cancer eventually metastasizing.
Stage III
T3, N0, M0, any grade or score
Description
The tumor has grown past the prostate, perhaps into the seminal vesicles, but has not, as far as can be determined, reached the lymph nodes or other
parts of the body.
Treatment
External beam radiation therapy is often used to treat Stage III cancers because it is less invasive than surgery and better suited for bulky tumors.
Surgery and watchful waiting also are options.
Prognosis
The chances that Stage III prostate cancers will progress in the 10 years following diagnosis are about 50/50. If the cancer has spread to the seminal
vesicles, this further increases the likelihood of a recurrence.
Stage IV
T4, N0, M0, any grade or score
Any T, N1, M0, any grade or score
Any T, any N, M1, any grade or score
Description
The tumor has metastasized to tissue or lymph nodes in the pelvic region or more distant parts of the body.
Treatment
Hormonal therapy is generally used to improve symptoms and delay the progress of the cancer for another two to three years. If the cancer has spread
to only the lymph nodes, hormonal therapy may be used for a longer amount of time.
Prognosis
If Stage IV prostate cancer has spread to the lymph nodes at the time of receiving hormonal therapy, there is a continued risk of developing
additional metastatic cancer within 10 years following the treatment.
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