Staging and grading of prostate cancer helps understand the extent to which the cancer has spread in the body. Doctors find the information helpful in determining the correct treatment. Read on to know more about the clinical and pathologic staging of prostate cancer…
Prostate cancer is one of the most common cancers in men. The walnut shaped prostate gland produces a seminal fluid that provides a safe environment for the sperms. Enlargement of prostate is common in the elderly. Enlarged prostate does not necessarily indicate occurrence of cancer. Various tests and biopsy help diagnose prostate cancer. The aggressiveness may vary from patient to patient. Staging and grading of prostate cancer helps determine the course of the treatment and bring uniformity in the treatment. Learn about how prostate cancer is staged and what does grading indicate, from the description given below.
Prostate Cancer
Clinical Staging
A simple blood test known as ‘PSA test’ helps measure PSA (prostate specific antigen) in the bloodstream. Usually, less than 4 ng/ml PSA is considered as the normal PSA value. Higher the PSA value, higher is the risk of prostate cancer. PSA above 20 ng/ml indicates 90% risk of cancer. Aging or other prostate problems can lead to a rise in PSA. So, a DRE (Digital Rectal Exam) test is performed to detect prostate cancer in men.
With his gloved finger inside the rectum, the doctor can feel, detect and estimate the growth of a tumor in prostate. The transrectal ultrasound and prostate biopsy help estimate the size of the tumor and spread of the cancer. If the results show that the cancer has spread outside the prostate, lymph node dissection or imaging studies can further provide the necessary information about the extent of the cancer.
When doctors report about the stage and grade of prostate cancer with the help of all these tests, it is called clinical staging. This involves staging and grading before surgery. With all this information, doctors can determine how to most effectively treat the cancer, and whether to remove the prostate or start radiation.
Pathologic Staging
It is the description of the nature and progress of prostate cancer which is based on the biopsy and surgical removal and examination of the prostate gland and/or the surrounding tissue, lymph nodes, etc. Along with the prostate gland, both seminal vesicles (the small sacs situated beside the prostate which store the semen) and/or lymph nodes are also removed as per diagnosis.
With the help of the reports, doctors can assign the pathologic stage. This staging can be more accurate than the clinical staging and it can help predict the patient’s outlook for survival (prognosis). But those who are not required to undergo a radical prostatectomy (surgery to remove the prostate gland and nearby tissues) have only clinical staging and grading.
Classification
Like all other cancers, TNM system is used for staging and grading of prostate cancer. T stands for the extent of the primary tumor, N describes whether the cancer has spread to the lymph nodes and if yes, how many lymph nodes are affected by it. M stands for metastasis. It describes whether the cancer has spread to distant organs. For example, the condition can be described as T1N1M0 or T3N3M1.
When the cancer is confined to the prostate gland, and the tumor is very small, it is described as stage I. When the size and/or number of tumors grow, it is described as stage II. Small tumor is expressed with a smaller number like T1. When the cancer spreads to the capsule that encloses the prostate gland, it is called stage III cancer. During this stage, it usually spreads to the nearby lymph nodes and seminal vesicles. When the cancer starts invading nearby and distant organs, the stage is called stage IV.
The Gleason grading system involves use of Gleason score along with other parameters to describe and estimate the spread of cancer. A cylindrical sample of prostate tissue is removed through the rectum during biopsy. This sample or the sample after the surgery is examined under a microscope. The pattern of tumor determines the Gleason score or grade of the tumor. The Gleason grade range is 1-5 and grade 5 has the worst prognosis. It is difficult to recognize the glands in Grade 5 tissue.
Depending upon the nature of the cancer, doctors can advise a patient to wait and watch the growth of the gland and can take the decision later. Surgery, chemotherapy, radiation therapy, hormone replacement therapy, are the options of cancer treatment. Staging and grading of cancer help determine the correct treatment and save the life of the patient. Prostate cancer patients can be 100% cured if the cancer is detected in an early stage.
