Understanding The Stages Of Prostate Cancer
Prostate cancer is one of the leading causes of cancer-related deaths of older males, usually occurring between the ages of 65 and 75 years. Unfortunately, the complexity of prostate cancer is difficult to understand without accurately determining where the tumor cells are and the extent to which they have spread outside the prostate gland. Doctors use a classification known as staging to understand the stages of prostate cancer and to gauge the degree of its growth and spread (National Cancer Institute) [1].
PROSTATE CANCER PROGNOSIS
Every type of prostate cancer is different. Therefore, notion the current stage of the cancer at the time of diagnosis is crucial in determining further prognosis (the progression of the disease and whether there is a chance of recovery).
THE WAYS PROSTATE CANCER SPREADS IN THE BODY
There are three ways the cancer may spread. The cancer can invade normal surrounding tissue, travel through the lymph vessels, and it can also go through the blood via the veins and capillaries to affect other parts of the body.
Cancer cells within the primary tumor (in the prostate gland) can wreck away from the initial status and cause a secondary tumor to form. This is known as metastasis and it is what makes prostate cancer and other cancers so difficult to treat. It is important to know that the secondary tumor, despite not being in the prostate gland, is composed entirely of prostate cancer cells. Therefore, it will be called metastatic prostate cancer.
THE TNM SYSTEM OF PROSTATE CANCER STAGING
Pathologists primarily use the TNM System (Tumor, Nodes, Metastasis) for diagnosing the unusual stage of prostate cancer and predicting future prognosis (Robbins Basic Pathology, 7th Edition) [2].
T1 – This is the first stage. The tumor is runt and is present only in the prostate gland. It is medically defined to be a nonpalpable lesion, which means it cannot be felt by hand during a normal rectal examination. There are three further sub-stages in this stage (T1a, T1b, and T1c) that rate how much of the tissue consists of the tumor from TURP tissue (transurethral resection of the prostate); which is acquired from a common operation used for benign prostate hypertrophy (BPH). It is important to note that the cancer at this stage is strictly local and has not spread.
T2 – In this stage, the tumor can be felt using a digital rectal exam and also through ultrasound. Professionally, there are three sub-stages (T2a, T2b, and T2c) that measure the involvement of the tumor in each lobe. If it is T2b, over 50% of only one lobe is keen. If it is classified as T2c, then both lobes are affected. These cancers are usually local and confined to the prostate gland.
T3 – This stage denotes a spreading tumor. The tumor cells will begin to move to nearby tissues and the seminal vesicles. This stage has three sub-stages (T3a, T3b, and T3c). T3c indicates seminal vesicle invasion. T3 cancers are also usually regional and have not yet spread to the lymph nodes of the body.
T4 – In this stage, the prostate cancer has spread to organs and tissues nearest to the prostate (contiguous organs and supporting structures). It has metastasized but only in the regional location. It is during this stage of prostate cancer that accurate diagnosis is extremely important. There are two sub-stages in the T4 stage – T4a and T4b. T4a signifies the invasion of the bladder neck, rectum, or external sphincter. The classification of T4b indicates the invasion of the levator ani mucle or pelvic floor. This cancer generally spreads to the lymph nodes, bones, liver, and lungs.
N Stage – It is in this stage when the prostate cancer is beginning to afflict the entire body. N staging is used to detect the tumor’s spread into pelvic lymph nodes more specifically. There are four sub-stages (N0, N1, N2, and N3).
M Stage – This is the stage that classifies metastasis of the prostate cancer to distant lymph nodes and bones. There are two sub-stages (M0 and M1), with the M1 sub-stage being further divided into M1a, M1b, and M1c. The purpose of these stages is to more accurately recount the spread of the cancer by pathologists. M1b denotes bone metastases and M1c means other distant sites are affected.
THE GLEASON Salvage STAGING SYSTEM
Another cancer staging system commonly used to classify the stages and prognosis of prostate cancer is the Gleason System. It is used to grade prostate cancer tissue based on how it looks under a microscope and the score ranges from 2-10. If the Gleason procure is low, it means the tissue is similar to normal prostate tissue and is less likely to spread. A high Gleason catch means the tissue is very different from normal tissue and is more likely to spread (metastasize). The TNM system is usually combined with the Gleason score to describe the current stage of prostate cancer (WebMD) [3].
Stage I – Cancer is only found in the prostate gland. It cannot be felt or seen by imaging. It is usually found accidentally during surgery for benign prostate hyperplasia. The Gleason derive is gross.
Stage II – The cancer is now more advanced but it has not spread outside the prostate. The Gleason score ranges from 2-10.
Stage III – The cancer has spread beyond the outer layer of the prostate and to local tissues. It generally invades the seminal vesicles. The Gleason score ranges from 2-10.
Stage IV – The cancer has metastasized to lymph nodes near or distant from the prostate to other parts of the body – such as the rectum, bones, bladder, liver, or lungs. It often spreads to the bones and the Gleason derive ranges from 2-10.
THE IMPORTANCE OF EARLY DIAGNOSIS AND TESTING
Prostate cancer can be deadly, especially when it becomes metastatic. Therefore, it is highly critical to determine the correct stage to receive the best treatment and for doctors to predict the prognosis.
Still confused? Visit this link to the website of the National Cancer Institute to learn more about what you need to understand about prostate cancer, such as the extremely important types of tests and treatments that work to classify the stages and more. Do not wait until it is too late. The sooner you visit your doctor and receive reliable and frequent check-ups, the more preparation and time you will have to overcome prostate cancer in the event it shows up in the future. Build the healthy choice.
WORKS CITED
[1] National Cancer Institute: “Prostate Cancer Treatment”; 5-23-2008: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2
[2] Robbins Basic Pathology, written by Vinay Kumar, MD, Ramzi S. Cotran, MD, Stanley L. Robbins, MD; “Staging of Prostatic Adenocarcinoma Using the TNM System”, Chapter 18, pg. 669
[3] WebMD: “Prostate Cancer Stages I-IV”; reviewed by Louise Chang, MD, 10-14-2008:
http://www.webmd.com/prostate-cancer/guide/prostate-cancer-stages
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