The staging of prostate cancer

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From lung cancer to breast cancer, all cancers have their own unique method of staging when cancer is found.  The staging of cancer is a way for doctors to describe the extent of the disease when they talk with one another about a person’s cancer. Staging of cancer gives doctors the information they need to know on how big the tumor is, whether it has spread or not and if it has spread, where has the cancer gone to. 

For men who have been given a diagnosis of prostate cancer, staging will one of the first steps completed and is one of the most important factors doctors use in choosing treatment options and predicting a man’s prognosis for this disease.

Staging is necessary for several reasons:

·      It helps the doctor decide the best way to treat the cancer

·      It can determine the chance of recovery or prognosis

·      It can help find clinical trials a person might be able to join

Testing for prostate cancer

When a man is diagnosed with prostate cancer, the initial staging is based on the results of PSA blood tests, biopsies, and imaging tests.  This phase of staging is referred to as clinical staging.

·      PSA blood test is used primarily to screen for prostate cancer and it measures the amount of prostate specific antigen (PSA) in the blood.  PSA is a protein produced by both cancerous and noncancerous tissue in the prostate gland.

The higher the level of PSA is an indication of a more advanced cancer.  The doctor will want to know how fast the PSA levels have been rising from test to test as a faster increase could indicate a more aggressive tumor.

·      A biopsy of the prostate can be done in the doctor’s office and the results from this can tell what percent of the prostate is involved.    It can also determine a Gleason score which is a number from 2 to 10 showing how closely the cancer cells look like normal cells when viewed under a microscope.  If the score is less than 6, it suggests the cancer is slow growing and not aggressive.  A higher number indicates a faster growing cancer that is likely to spread.

·      Imaging tests used to determine prostate cancer can include CT scans, MRI, or a bone scan.

How prostate cancer is staged and what they mean

·      Stage I cancer

This stage is known as localized cancer as the cancer has been found in only one part of the prostate.  Stage I cancers cannot be felt during a digital rectal exam or seen with imaging tests.  If the PSA is less than 10 and the Gleason score is 6 or less, stage I cancer is most likely a slow growing cancer.

·      Stage II cancer

This stage of cancer is still localized and has not spread beyond the prostate but is more advanced than stage I.  In stage II, the cells are less normal than stage I and may grow more rapidly.  There are two types of stage II prostate cancer:

·      Stage IIA – found only on one side of the prostate

·      Stage IIB – found in both sides of the prostate

·      Stage III cancer

This stage of cancer is called locally advanced prostate cancer and has spread outside the prostate into local tissue such as the seminal vesicles, the glands that make semen. 

·      Stage IV cancer

This stage of cancer has spread to distant parts of the body such as nearby lymph nodes or bones of the pelvis or spine.  It could have spread to other organs such as the bladder, liver, or lungs. 

Men diagnosed with stage I, II or III prostate cancer, the goal is to cure the cancer by treating it and keeping it from returning.  Men diagnosed with stage IV prostate cancer, the goal is to improve symptoms and to prolong life as in most cases, stage IV prostate cancer is not curable.

Depending on the stage of prostate cancer along with the PSA and Gleason score, will help the doctor to decide on the best treatment taking into account a man’s:

·      Age

·      Overall health

·      Symptoms

·      Side effects of treatment

·      What chance the treatment can cure the cancer

Staging of prostate cancer can be very complex.  It is imperative that any man diagnosed with this disease to ask his doctor and other members of his cancer care team to explain the staging to him in a way he can understand.