If you are diagnosed with prostate cancer you should know how this disease is progressing and you should understand medical terminology. This information should help you to take serious decisions when chosing appropriate methods of treatment.
Course of the disease.
In most cases cancer of the prostate is slow-growing. In fact, aged men do not need treatment because tumor does not influence life time and the disease courses without symptoms.
Condition connected with slight change of shape and size of cells of prostate is called prostatic intraepithelial neoplasia (PIN) and a half of men over 50 years are diagnosed with it. PIN is considered precancerous disease.
Gleason staging system is used to help to evaluate the prognosis of cancer of the prostate.
- Biopsy. Tissue samples of prostate tumor are taken. Obtained material is going in laboratory for a microscopic examination.
- In laboratory every sample assigns a grade from 1 to 5: one means that sample has only healthy cells and five means the sample has pathological cells.
- The two grades of two most specific tumor samples are added together to get a Gleason score (from 2 to 10). Higher Gleason score means a worse prognosis.
Prostate cancer stages.
Stages do characterize where cancer have spreaded. Doctor needs this information to choose treatment. To define cancer stage the next examinations can be made:
- Digital rectal examination
- Blood tests
- Bone scans
- Computerized tomography
- Magnetic resonance tomography
- Biopsy of prostate and lymphatic glands
There are two systems of describing prostate cancer stages – Whitmore-Jewett staging
and TNM.
Whitmore-Jewett staging system
In this case to describe stage of disease are used letters of A, B, C, D:
A – the tumor has microscopic size and it is not detectable when palpation
B – the tumor or lump are felt (without metastasis)
C – the tumor with metastasis spreaded to the organs located near prostate
D – the tumor with great metastasis spreaded to lymphatic glands and other organs
TNM staging system
Cancer stages can be described also in TNM system. TNM stands for Tumor, Nodes, Metastases.
T – characterises process of primary tumor
T1 – the tumor is not detectable while visual examination and on X-ray picture. Cancer cells are presented in tissue samples taken during prostate hyperplasia operation or during biopsy.
T1a – cancer cells are detected in less than 5% of tissue that was removed. Gleason score is less than 7.
T1b - cancer cells are detected in more than 5% of tissue that was removed. Gleason score is more than 7.
T1c – cancer cells are detected in tissues taken during biopsy (performed due to an elevated serum PSA)
T2 – the tumor can be felt but it does not spread outside capsule covering prostate.
T2a – the tumor is in less than 50% of one part of prostate.
T2b – the tumor is in more than 50% of one part of prostate.
T2c – the tumor is in both parts of prostate.
T3 – the tumor is spreaded on other organs including seminal vescile.
T3a – the tumor is spreaded on other organs but not in seminal vescile.
T3b – the tunor is spereaded on seminal vescile.
T4 – the tumor is spreaded on other organs near prostate, for example, on rectum.
To detect metastasis to other organs it is necessary to make some additional examinations. Prostate cancer often does metastasis to lymphatics glands, bones, lungs and other organs.
To describe metastasis marks of M and N are used.
N – characterises spreading of tumor on lymphatic glands.
Nx – it is not clear if lymphatic glands are invaded or not.
N0 – the tumor is not found in lymphatic glands.
N1 – the tumor is found in one lymphatic gland in small pelvis caverna and it has size of not more than 2 sm.
N2 - the tumor is found in one lymphatic gland in small pelvis caverna. It has size of more than 2 cm but less than 5 cm. The other variant is when the tumor is found in several lymphatic glands in small pelvis caverna but tumors have size of less than 5 cm.
N3 – at least one tumor in lymphatic glands has a size of more than 5 cm.
M – describes spreading of tumor in other organs.
Mx – it is not clear if there is metastasis to other organs.
M0 – metastasis are detected only in prostate and in the nearest lymphatic glands.
M1 – the tumor does metastasis to lymphatic glands beyond small pelvis and\or into other organs (bones, lungs, livers and brain).
Prognosis for prostate cancer.
Almost all cancerous growths of prostate (91%) are detected before they spread beyond prostate. If cancer is diagnosed being at this stage, in 99% of cases patients can live at least 5 years. But the prognosis of survival exacerbates when the tumor did metastasis to other organs.
The second detecting of prostate cancer after a year or more of treatment is called recurrence. Cancer can recur in prostate (even if it was removed) and in other organs including bones. To treat recurescence can be used methods different from those that were used for primary tumor treatment.
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