Prostate cancer is a form of cancer that grows in the prostate, a gland in the male reproductive system. Prostate cancer is most common in the developed world with cumulative rates in the developing world and it is the sixth leading cause of cancer among men globally.
Based on the three factors such as TNM stage, PSA and Gleason score, the patients are classified into high, intermediate and low risk groups. The low risk patients are usually treated with radical prostatectomy or radiotherapy alone.
Patients who are classified in intermediate risk disease are usually treated with radiotherapy and a short duration (less than 6 months) of hormonal therapy. It depends upon surgeon’s decision to prefer for robotic radical prostatectomy or not. Although the role of surgery in these patients remain uncertain, and the patient with high risk disease are usually treated with radiotherapy and a long duration of hormonal ablation. Many high risk patients are not cured by this treatment.
Stages of Prostate Cancer Using TNM System:
Prostate cancer is staged using the TNM system. This is used all over the world. It separately assesses the tumor (T), lymph nodes (N) and secondary cancer (metastases – M).
- T – For tumor — describes the size of the main area of prostate cancer.
- N – For nodes — describes whether cancer has spread to any lymph nodes and to what extent.
- M – For metastasis — means distant spread of prostate, for example, to the bones or liver.
Different Stages of Prostate Cancer:
There are four Stages of Prostate Cancer that we have discussed it below. Following are the different Stages along with their treatments.
In stage I, cancer is found in the prostate only. The cancer is found by needle biopsy or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower. It is found in one-half or less of one lobe of the prostate. It cannot be felt during a digital rectal exam and is not visible by imaging. They usually grows very slowly and do not show any symptoms at the early stage. The cancer is very small and completely inside the prostate gland, which feels normal during a rectal examination.
- Surgery to remove the prostate gland (called radical prostatectomy). Since it is too small, surgery is not preferred at this stage.
- Watchful Waiting or Active Surveillance. In this therapy, the doctors closely watch the tumor to see if it causes any symptoms or it appears to be growing. Common test such as PSA is usually done in this method.
- Radiation Therapy: It uses high frequency x-ray beam to kill prostate cancer cells or to refrain them from being divided and grow rapidly.
In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. If it is not treated then it is likely to spread outside of prostate. If the patient is so elder or having more complex diseases or after watchful waiting there are no any significant increase in growth of cancer tumor, then in such cases
Radical Prostatectomy and Radiation Therapy are the preferred options. Stage II is divided into stage IIA and stage IIB.
In stage IIA, cancer:
The PSA level is lower than 20 but higher than 10 and the Gleason score is 6-7. It is found by needle biopsy or in a small amount of tissue during surgery for other reasons.
In stage IIB, cancer:
Such cancer is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10. In some cases, the tumor has not spread outside the prostate and such tumors cannot be felt during a digital rectal exam and not visible by imaging. In such cases, the PSA level is 20 or higher and the Gleason score can range from 2 to 10.
- Radiation therapy with ADT
- Hormone Therapy: It is used to stop the production of testosterone and all androgens either temporarily or permanently. Prostate cancer grows when it is exposed in presence of testosterone, so this therapy is used to stop its production.
- Radical prostatectomy and sometimes proceeded by hormonal therapy. In some cases the lymph nodes are removed.
- Brachytherapy and external beam radiation combine. The radiation theraphy also includes follow up of hormone therapy.
In this stage, the cancerous cell has significant growth. Cancer tumor has spread beyond the prostate gland but not has reached to bladder, lymph nodes, rectum or any other organs. Some times for elders doctors prefer to go for watchful waiting stage. This is preferred only if patient is having many sever complications or other illness.
The PSA can be any level and the Gleason score can range from 2 to 10.
- External beam radiation plus hormone therapy
- Radical prostatectomy in selected cases. Many times pelvic lymph nodes are also removed. Radiation therapy may be followed after this surgery.
- In some cased only hormone therapy is preferred.
This is the final stage of the cancer and usually it is not curable. It has grown into the bladder or rectum, or has spread to the lymph nodes or another part of the body. It may spread to the bones, liver or lungs type of distant places. In this case, removing any part of the body will not solve the problem. It is preferred to wait and watch for the elder person.
- Hormone therapy
- External beam radiation plus hormone therapy (in selected cases)
- Surgery such as TURP which helps in reducing symptoms such as bleeding
- Some reliving treatments are also done to reduce symptoms such as bone pain.
We have discussed here different stages of prostate cancer along with their Prostate Cancer Treatment.
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