This page details the staging process for the most common form of prostate cancer. Once you receive an initial diagnosis, your medical team will aim to determine the stage of your prostate cancer. They will seek to understand whether the cancer is confined to the prostate (referred to as ‘localized’) or if it has spread to other parts of your body (referred to as ‘non-localized’).
Procedures for Determining the Stage of Prostate Cancer
Determining the stage of prostate cancer includes evaluating MRI or bone scan results, PSA levels, and biopsy findings.
Gleason Grading:
When the laboratory receives prostate biopsy results, the extent of cancer in the tissue sample is assessed. The grading system employed for this purpose is known as the Gleason Grading system.
What is Gleason Score :
If prostate cancer is detected, it will be evaluated using the Gleason grading system, which is the standard method for classifying prostate cancer. This system provides doctors with an accurate understanding of how aggressive or concerning the cancer might be.
Cancerous cells appear different from normal cells under a microscope. Normal cells are typically uniform in size and appearance, whereas cancerous cells may lack a clear shape and are difficult to differentiate from one another.
The Gleason grading system assigns a score between 3 and 5 based on the cells’ appearance, indicating the level of abnormality. For instance, Grade 5 cells appear more irregular compared to Grade 3 cells.
The process involved in determining a Gleason Score:
The histopathologist will follow these steps to assign an accurate Gleason Score to your tissue sample:
– Identify the predominant type of cell structure present, assigning a score between 3 and 5 based on the appearance of cancer cells.
– Evaluate the second most prevalent type of cancerous cell using the same grading scale.
– Combine the two scores to determine the total Gleason score out of 10 (for example: 3+3 equals 6 out of 10).
Assessing your Gleason Score:
Gleason Score | Type of Cancer |
6 | Slow Progression |
7 ( 3+4 or 4+3) | Moderate Grade |
8 ( 3+5, 4+4 , 5+3) | More Aggressive |
9 ( 4+5, 5+4) | More Aggressive |
10 (5+5) | More Aggressive |
A Gleason Score of 4+3 is higher than a score of 3+4.
Gleason Groups and Risk Groups:
Additionally, a more recent grading system exists that adjusts the Gleason Scores into risk categories, ranging from 1 to 5.
Gleason Score | Grade Group Number | Risk Profile |
3+3 | Grade Group 1 | Low Risk |
3+4 | Grade Group 2 | Intermediate Risk |
4+3 | Grade Group 3 | Intermediate Risk |
3+5 | Grade group 4 | High/Very High Risk |
4+4 | Grade group 4 | High/Very High Risk |
5+3 | Grade group 4 | High/Very High Risk |
4+5 | Grade group 5 | High/Very High Risk |
5+4 | Grade group 5 | High/Very High Risk |
5+5 | Grade group 5 | High/Very High Risk |
Scans:
Men might require diagnostic scans, such as an MRI scan, a bone scan, or sometimes both.
MRI Scans:
An MRI scan employs magnets to create detailed images of the body’s interior. It can help detect prostate cancer that has spread to the seminal vesicles or lymph nodes.
Bone Scans:
A bone scan involves injecting a radioactive dye into the body. This dye takes about four hours to circulate and settle in the bones.
Afterward, a special camera captures images of the bones to determine if prostate cancer has spread.
Previous injuries, fractures, and arthritis will also appear on a bone scan, making it challenging to pinpoint cancerous areas. In such cases, additional X-rays may be taken of the specific area.
Staging:
Once all the information from the Gleason Grading and scans is collected, a stage of prostate cancer can be assigned.
The TNM system is used to classify prostate cancer:
– T represents Tumor size,
– N indicates Lymph Node involvement,
– M signifies Metastases (the spread of cancer to other organs or bones).
The table below explains the TNM stages. It might be helpful to refer to the diagram beneath the table, which illustrates the specific areas of the body being discussed.
Tumors:
Tumors | What it means |
T | stands for Tumor size |
T1 | The cancer is in its early stage and not detectable during a prostate examination, indicating localized prostate cancer. |
T2 | The cancer can be felt during a prostate examination on either one or both sides of the prostate, indicating localized prostate cancer. |
T2a (T2 Subcategory) | The tumor involves half of a prostate lobe or less. |
T2b (T2 Subcategory) | The tumor involves more than half of a prostate lobe but not both lobes. |
T2c (T2 Subcategory) | The tumor involves both lobes |
T3 | The cancer can be felt on the surface of the prostate, which may suggest it has extended beyond the prostate capsule or to the adjacent seminal vesicles |
T3a (T3 Subcategory) | The cancer has spread to the capsule of the prostate on one side |
T3b (T3 Subcategory) | cancer has spread to the capsule of the prostate on both sides. |
T3c (T3 Subcategory) | The tumor has invaded the seminal vesicle(s). |
T4 | The cancer has extended beyond the prostate to the neck of the bladder, the rectum, and possibly other parts of the body. |
Lymph Nodes:
The human body features a unique network known as the lymphatic system, responsible for draining fluids and supporting immune function. This system plays a crucial role in cancer, including prostate cancer, as it serves as a pathway for cancer cells to spread throughout the body.
TNM Code what is Means
N in the TNM staging system refers to the status of lymph nodes:
– NX: Lymph nodes were not measured.
– N0: No cancer detected in the lymph nodes.
– N1: Cancer has spread to the lymph nodes.
Metastases:
Metastases in cancer refer to the spread of cancer cells to distant parts of the body, including organs or bones.
TNM Code What it Means
M stands for Metastases, indicating whether cancer has spread to other parts of the body beyond the primary site.
– MX: Spread of cancer not assessed.
– M0: No signs of cancer spreading to other areas.
– M1: Definitive evidence showing cancer has spread to other areas of the body.
Assigning a grade to each of these three aspects—T (tumor), N (lymph nodes), and M (metastases)—enables the medical team to strategize the most effective treatment plan.
Key Terms:
Localized Prostate Cancer: This refers to cancer that remains confined within the prostate gland.
Locally Advanced Prostate Cancer: This describes cancer that has extended beyond the confines of the prostate gland, possibly affecting nearby structures like the seminal vesicles.
For detailed information on the treatment options available for both localized and locally advanced prostate cancer, please refer to our dedicated pages on Localized Prostate Cancer.
Metastatic Prostate Cancer (Non-Localized): This indicates cancer that has spread beyond the prostate gland to other parts of the body, such as organs or bones.
For comprehensive insights into the treatment approaches for metastatic prostate cancer, please visit our dedicated pages on Non-Localized Prostate Cancer.