Prostate Cancer — Diagnosis and Staging
There are several important elements of assessing
prostate cancer
:
Prostate Cancer Diagnosis
When a doctor finds abnormal results during a
Digital Rectal Examination (DRE) and/or from a
Prostate-Specific Antigen (PSA) test and suspects cancer, the patient
will be sent to have a biopsy.
During a
biopsy
, samples of prostate tissue are taken through a small needle that may be inserted
into the
rectum
or through the perineum into the prostate. An ultrasound probe inserted into the
anus
guides the needle. The procedure is uncomfortable but is usually not very painful.
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Prostate Cancer Grading
As part of the diagnosis process, prostate cancer is graded and staged. The grade describes how aggressive the cancer is
and how fast it is likely to grow.
Most pathologists use the Gleason scale to grade prostate cancer. They look for
the most common type of cancer cell in the sample and assign it a number between
1 and 5 — the higher the number, the more abnormal the cells are. Another
number is assigned to the second most common type of cell in the sample. The Gleason
score is the sum of these two numbers (which will be between 2 and 10).
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Prostate Cancer Staging
Cancer staging is standardized for most types of solid tumors. The Staging System
of the American Joint Committee on Cancer (also referred to as the TNM system) is
used most often by doctors to describe a patient's cancer. The TNM system involves
three scores that describe:
- The tumor type
- Whether or not lymph nodes are involved
- How far the cancer has spread
|
T = Tumor |
|
T1: |
Cannot see tumor without using imaging techniques |
|
T2 - T4: |
Gradiations of sized and/or extent of the primary cancer |
|
N = Nodes |
|
NO: |
The cancer has not spread to lymph nodes |
|
N1: |
Cancer has spread to the lymph nodes |
|
M = Metastasis |
|
MO: |
No distant metastasis to other organs |
|
M1: |
Metastasis to other organs |
Once the Gleason Score and the TNM categories have been established, this information
is combined to determine the cancer’s stage:
- Stage I: The prostate cancer cannot be detected through a DRE or an imaging machine
(MRI, CT scan, etc). Most likely, it was found during a surgical procedure and has
a very low Gleason score.
- Stage II: The prostate cancer has not spread to the lymph nodes
or other parts of the body. It was found during a
DRE, PSA,
needle
biopsy
, or transrectal
ultrasound.
- Stage III: The prostate cancer has begun to spread beyond the prostate.
It may have spread to the seminal vesicles, but it has not spread to the lymph nodes
or other parts of the body.
- Stage IV: The prostate cancer has spread to tissues next to the
prostate (other than the seminal vesicles), to lymph nodes, and/or to other, more
distant sites in the body.
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