Staging
Of Prostate Cancer As in other cancers it is important to assess at which
level the cancer is at the time of diagnosis. This is called staging. It might
involve some X rays, perhaps a bone scan and more blood tests such as a acid phosphatase,
which correlates well with the presence of metastases in lymph nodes. A transrectal
ultrasound (TRUS) and a TRUS guided prostate biopsy in 6 different areas of the
prostate would also be required. The prostae biopsy material can be analyzed by
the pathologist according to how well differentiated the cells look under the
microscope. According to this a compariosn is made between the grading of the
normal looking cdells and the worst looking prostate cancer cells in the biospy
specimens. These scores are added and a Gleason score is obtained. The higher
the number, the more aggressive the cancer cells are believed to be. Mosty scores
are in the 6 to 7 (out of 10) Gleason score category. An 8 (out of 10) score would
be a more aggressive cancer. Finally the doctor may want to employ a CT
or MRI scan to delineate any involvement outside the prostatic capsule. The
following stages have conventionally been used:
| Staging
of Prostate Cancer (Whitmore-Jewett Staging) |
| Stage | Prostate
cancer involvement | | A | positive
PSA and confirmed by biopsy, confined to one lobe, is clinically not visible by
imaging techniques or exam | | B
| Is clinically palpable by rectal exam; visible
on TRUS, subclasses confined to one or both lobes |
| C | Extends
through prostatic capsule with local regional metastases,sometimes with seminal
vesicle invasion | | D | prostate
is fixed due to extensive invasion of adjacent structures including pelvic bone,
may also have distant metastases | The significance
of this staging procedure becomes evident when the prostate cancer survival rates
are reviewed (see below):
|
Prostate cancer survival |
| Stage | 5-year
survival | 10-year survival |
| A | 100%
| 97% |
| B | 89%
| 71% |
| C | 80%
| 66% |
| D | 29%
| 0% |
It is very clear from these statistics and the knowledge of the biology
of prostate cancer that there is not such thing as a "clinically unimportant"
prostate cancer. If the early cancer is missed (stage A or B), it progresses relentlessly
into stage C or D and kills the patient. The TNM staging system is an alternative
staging system and was developed bu the American Joint Committee on Cancer. Here
is a link to the TNM
staging system for prostate cancer. This table also tells that
as long as the patient has a localized prostate cancer (stage A), there is hope
for long-term survival. For the first time in millenniums with the help of the
PSA test in combination with a rectal examination we have the tools of changing
history. With prostate cancer we are at a similar point in time where we were
with cervical cancer cure rates in women in the 1960's and 1970's. Every educated
woman in the world knows that a yearly Pap test and pelvic examination can prevent
cancer of the cervix and ovarian cancer. Every man from now on will accept that
he has a responsibility to prevent prostate cancer. Here is a calculator
for your risk given your particular circumstances, developed by the National
Cancer Institute (click "continue to calculator").
| With prostate cancer early diagnosis, |
| like with any other cancer, |
| is the key to successful cures! |
This reinforces the fact that an annual PSA test and
rectal prostate examination needs to be done in every man beyond the
age of 45 to 50 to detect and treat prostate cancer early.
|
