Diagnosis of Prostate Cancer

What happens after diagnosis of prostate cancer?

Staging:

After the biopsy has been performed and malignant cells are indeed found the next step is the cancer will be Staged. What is Staging? Staging is a method that doctors use to describe :
how big the tumor is if it has spread the lymph nodes
if it has spread locally or to distant organs

Staging for prostate cancer is done by using one of two staging techniques. The most common staging system used is the TNM system or Tumor, Node, Metastases system. The second system used is the Jewett-Whitmore system where prostate cancer is classified first as stage A, B, C, or D. Stages A and B cancers are considered curable. Stages C and D are treatable, but their prognoses are not that good. A number is then assigned to describe specific conditions within each stage.



TNM System
The TNM (tumor, node, metastases) system stages are similar to those of the Jewett-Whitmore system, but with more specific alphanumeric subcategories.

Primary tumor (T):
TX Tumor cannot be assessed


T0 No evidence of primary tumor


T1 Clinically not palpable or visible by imaging

T1a Found incidental to other surgery; present in 5% or less of tissue

T1b Found incidental to other surgery; present in 5% or more of tissue

T1c Identified by needle biopsy


T2 Tumor confined within prostate

T2a Involving half a lobe or less of prostate

T2b Involving half a lobe

T2c Involving both lobes


T3 Tumor extends through prostate capsule

T3a Extends through one lobe

T3b Extends through both lobes

T3c Extends into seminal vesicles


T4 Involves structures other than seminal vesicles

T4a Invades bladder neck, external sphincter, or rectum

T4b Invades muscles and/or pelvic wall




Regional Lymph Nodes (N):
NX Nodes cannot be assessed


N0 No regional node metastasis


N1 Single node metastasis, 2 centimeters (cm) or less at largest point


N2 Single node metastasis, 2 cm to 5 cm at largest point, or multiple nodes, no larger than 5 cm at largest point


N3 Metastasis larger than 5 cm in any node




Distant Metastasis (M):
MX Metastasis cannot be assessed


M0 No distant metastasis


M1 Distant metastasis

M1a Distant lymph node(s) involved

M1b Bone(s) involved

M1c Other site(s) involved




Grading :

Grading : Also along with Staging the tumor cells will be graded. What is Grading?

Grading is a comparison of the tumor cells to normal cells and a distinction is made on how far removed from normal the cancer cells are. Prostate cancer is graded with a special system called Gleason Grading in the United States. A grade of 1 thorough 5 is given to each of two samples taken from different parts of the tumor by putting the tumor cells under a high powered microscope and looking at them. The sum of the two are used to get a Gleason score.

Gleason scores of 2 to 4 indicate that the cells are well differentiated, meaning the tissue is not too abnormal; 5 to 7 moderately differentiated; 8 to 10 poorly differentiated. Higher scores suggest aggressive tumors that likely require aggressive treatment.

Grading is an important determining factor when a oncologist is making a decision on how to go about treating your specific cancer.

Once a tumor has be staged and graded a determination on the correct plan of action can be made by your primary oncologist along with a medical oncologist, surgical oncologist or radiation oncologist