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Staging Of Prostate Cancer

Staging of prostate cancer is as important as in other cancers. It allows the physician to assess at which level the cancer is at the time of diagnosis. This is called staging. It might involve some X rays, perhaps a bone scan and more blood tests such as a acid phosphatase, which correlates well with the presence of metastases. A transrectal ultrasound (TRUS) and a TRUS guided prostate biopsy in 6 different areas of the prostate would also be required. The prostate biopsy material can be analyzed by the pathologist according to how well differentiated the cells look under the microscope. A comparison is made between the grading of the normal looking cells and the worst looking prostate cancer cells in the biopsy specimens. These scores are added and a Gleason score is obtained. The higher the number, the more aggressive the cancer cells are believed to be. Mostly scores are in the 6 to 7 (out of 10) Gleason score category. An 8 (out of 10) score would be a more aggressive cancer.

Finally the doctor may want to employ a CT or MRI scan to delineate any involvement of the cancer outside the prostatic capsule.

The following stages have conventionally been used:

Stages Of Prostate Cancer

Stages Of Prostate Cancer

 

Staging of Prostate Cancer (Whitmore-Jewett Staging)

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Stage:

A :    Positive PSA and confirmed by biopsy, confined to one lobe, is clinically not visible by imaging techniques or exam

B :    Is clinically palpable by rectal exam; visible on TRUS, subclasses confined to one or both lobes

C:    Extends through prostatic capsule with local regional metastases,sometimes with seminal vesicle invasion

D:    Prostate is fixed due to extensive invasion of adjacent structures including pelvic bone, may also have distant metastases

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The significance of this staging procedure becomes evident when we look at the cancer survival rates (see below).

Prostate cancer survival:

Stage 5-year survival 10-year survival
A 100% 97%
B 89% 71%
C 80% 66%
D 29% 0%

 

It is very clear from these statistics and the knowledge of the biology of prostate cancer that there is not such thing as a “clinically unimportant” prostate cancer. If the early cancer is missed (stage A or B), it progresses relentlessly into stage C or D and kills the patient. The TNM staging system is an alternative staging system and was developed bu the American Joint Committee on Cancer. Here is a link to the TNM staging system for prostate cancer (thanks to en.wikipedia.org for this link).

This table also tells that as long as the patient has a localized prostate cancer (stage A), there is hope for long-term survival. For the first time in millenniums with the help of the PSA test in combination with a rectal examination we have the tools of changing history. With prostate cancer we are at a similar point in time where we were with cervical cancer cure rates in women in the 1960’s and 1970’s. Every educated woman in the world knows that a yearly Pap test and pelvic examination can prevent cancer of the cervix and ovarian cancer. Every man from now on will accept that he has a responsibility to prevent prostate cancer.

Here is a calculator for your risk (thanks to deb.uthscsa.edu for this link) given your particular circumstances, developed by the National Cancer Institute (click “continue to calculator”).

Like with any other cancer early diagnosis is key to a successful cure.

This reinforces the fact that an annual PSA test and rectal prostate examination needs to be done in every man beyond the age of 45 to 50 to detect and treat prostate cancer early.

Did you know that male baldness and prostate cancer mortality are linked? see this link: https://nethealthbook.com/news/baldness-prostate-cancer-mortality-related/

References:

The following references were used apart from my own clinical experience:

1. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr.,et. al J.B. LippincottCo.,Philadelphia, 1993.Vol.1: Chapter on Prostate cancer.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.Chapter 233, p.1918-1919.

3. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T.DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on prostate cancer.

4. A Waghray et al. Cancer Res 2001 May 15;61(10):4283-4286.

5. BM Fisch et al. Urology 2001 May;57(5):955-959.

6. CC Parker et al. BJU Int 2001 May;87(7):629-637.

7. B Aschhoff Drugs Exp Clin Res 2000;26(5-6):249-252.

8. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

9. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc

10. John R. Lee: “Hormone Balance for Men – What your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation”, © 2003 by Hormones Etc.

11. Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008

12. Huggins, C., Stevens, R. E. Hodges, C. V. (1941). Studies on prostatic cancer, III. The effects of castration on advanced carcinoma of the prostate gland, Archives of Surgery, 43, 209–223.

Last modified: June 15, 2016

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.