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Prostate Cancer – Stages, Types and Grades

Prostate Cancer Stages

Prostate Cancer Stages - (Image Credit: Shutterstock)

30-Second-Summary
  • Prostate cancer is a major world health problem affecting 1 in 8 men. The Prostate Cancer risk factors include obesity, age, African-American race, and obesity.
  • Other prostate cancer risk factors involve geography. The condition is mostly diagnosed in North America, Australia, Northwestern Europe, and the Caribbean.
  • One of the causes of prostate cancer could be genetics. A father with this disease means the son is more likely to get it too.
  • There are several types of prostate cancer, but, by far, the most common is Acinar Adenocarcinoma, which proliferates in the glands of the prostate.
  • Physicians use the TNM (tumor, node, metastasis) scale to assess which of the prostate cancer stages you fall into, the Gleason Classification System to evaluate the cell progression, and the Staging System to classify cancer.
  • With good medical care and an understanding of the causes of prostate cancer, this condition may be very treatable if it’s caught early.

Overview

Considering that 1 in 8 men will receive a diagnosis of one of the types of prostate cancer in their lifetime, it is a major world health problem. According to the World Journal of Oncology[1], it’s also the second most common cancer to be diagnosed in men and the 5th leading cause of death overall.

The prostate is a gland in the pelvic area, which is responsible for producing the semen that carries the sperm. Because many men aren’t aware of the prostate cancer risk factors, it’s particularly important to get regular screenings for early detection.

Prostate Cancer: The Facts

Prostate cancer occurs when a tumor forms in the gland and begins to cause damage, and in some cases, it can metastasize to other areas of the body. There are several key prostate cancer risk factors.

Although there are several types of prostate cancer, by far the most common occurs when the cells develop in the glands of the prostate. Fortunately, this is slow-growing cancer and can often be treated successfully.

The risk of being diagnosed with this condition increases with age and is most common over the age of 50. Being African American is one of the key prostate cancer risk factors, although the reasons are undetermined, and so is obesity.

Finally, one of the causes of prostate cancer is genetics. Warning signs to watch for include difficulty urinating, blood in your semen and/or urine, bone pain, unexplained weight loss, erectile dysfunction, and a lighter urine stream. If you notice any of these symptoms, seek medical help immediately.

The Spread of Prostate Cancer

Spread of Prostate Cancer

Although cancer begins in the prostate gland, it can also spread outside of the area and travel to other parts of the body. As the prostate is a very slow-growing cancer, it may take a long time for this to happen, or with successful treatment, it may not happen at all. For this reason, the prostate often has a high likelihood of recovery if you catch it in the early prostate cancer stages.

The cells that have developed in the prostate gland can spread outside of this area by migrating to other nearby tissue, or they can metastasize through your blood. Also, they may travel through your lymph nodes or vessels to invade other areas in your system. There are several prostate cancer stages[2], which indicate the severity of the spread.

Often when prostate cancer migrates out of its original location, it goes to the bones initially and then to other parts of your system. Naturally, when the disease has spread and starts to progress through the prostate cancer stages, the focus of the treatment becomes slowing it as quickly as possible.

Are There Different Variants?

There are different types of prostate cancer and knowing the variant you have is crucial, as it drives treatment methods as well as outcomes. However, generally speaking, there isn’t a lot of variation.

By far the most common of the types of prostate cancer is Acinar Adenocarcinoma, which grows and develops within the glands of the prostate. A diagnosis of prostate cancer will mean that you have this type the vast majority of the time.

However, depending on the causes of prostate cancer, sometimes the cells develop in the ducts of the prostate, leading to the quickly spreading variant called Ductal Adenocarcinoma. There is also Transitional Cell Cancer, which begins in the urethra and bladder, and then rapidly moves over to the prostate.

Squamous Cell Cancer is one of the fast-spreading types of prostate cancer, which starts developing in the flat cells of the gland, and it moves much more quickly than Acinar Adenocarcinoma. Finally, there is a neuroendocrine condition called Small Cell Prostate Cancer, which occurs only rarely.

Evaluative Techniques for Diagnosing Prostate Cancer Stage

Diagnosing Prostate Cancer
A biopsy will confirm you have prostate cancer, and it will also indicate to the physician which further tests to carry out to decide which of the prostate cancer stages you fall into right now. The doctor will likely carry out a digital rectal exam to evaluate the level of growth of cancer and possibly a transrectal ultrasound.

To get more detailed information about which of the types of prostate cancer you have, medical professionals may do an MRI of your prostate or a CT scan of the abdomen to track any spreading. To check whether the cells have gone into your bones, they may do a nuclear medicine bone scan.

If doctors suspect that cancer has spread to the lymph nodes, they may perform surgery on your pelvis to evaluate this possibility. One of the key tests for tracking the prostate cancer stages is the PSA, which measures the level of prostate-specific antigens in your blood.

TNM System of Categorizing Cancer Stages

Physicians classify the prostate cancer stages using the TNM system, which stands for Tumor, Stage, and Metastasis. When they examine the tumor, it is mainly to assess its size. There is a categorization system with 4 different stages of cancer size.

The Node classification refers to whether cancer has spread to the lymph nodes. There are only two categories, which are either N0 or N1. N0 means there are no cancer cells in the nodes and N1 indicates the presence of cells.

Metastasis evaluates whether cancer has spread to other parts of your body. N0 means there is no spread, and M1 means it has spread to regions outside of the pelvis area. If there are cells in the lymph nodes outside the pelvis, the rating is M1a, and if they’re in the bones, it’s M1b. Cancer cells in other parts of the body are designated as M1c.

Grading System for Prostate Cancer

As you progress through the prostate cancer stages, your medical team needs to be aware of the grading of the cells, meaning how they differentiate from normal, healthy cells. This helps to decide on the best course of treatment for you. For Acinar Adenocarcinoma, the Gleason Classification System is used to grade the cells based on a scale of 5 different levels.

A grade of 1, 2, or 3 indicates that the prostate cancer stages should progress at a very slow rate. If the cells are given a grade of 4 or 5, this indicates cancer that is likely to grow and spread fast, and grade 5 will move more quickly than 4.

To calculate the final Gleason score, the pathologist will do an evaluation and decide how many new patterns of cells they see. Then they will determine the rating for each and add them together for the final number.

Prostate Cancer Stages of Development

Prostate Cancer Stages of Development
Physicians will examine your TNM ratings plus your Gleason score and other data to decide on a stage grouping to classify your cancer. Based on the information, they will formulate the best course of treatment. The classification is as follows:

Stage 1

  • The disease has not spread outside of the prostate.
  • The physician can’t feel the tumor or view it on an imaging test.
  • The patient has a Gleason score of less than 6 and a PSA of less than 10.
  • The tumor takes up half or less than one side of the gland.

Stage 2A

  • The disease has not spread outside of the prostate.
  • The physician can’t feel the tumor or view it on an imaging test.
  • The tumor takes up more than half of one lobe but is not in both lobes.
  • The patient has a Gleason score of less than 7 and a PSA of less than 10.

Stage 2B

  • The disease has not spread outside of the prostate.
  • The physician may not feel the tumor or view it on an imaging test.
  • The tumor is in either one of the lobes or both.
  • The patient has a Gleason score of 7 and a PSA of less than 20.

Stage 2C

  • The disease has not spread outside of the prostate.
  • The physician may not feel the tumor or view it on an imaging test.
  • The tumor is in either one of the lobes or both.
  • The patient has a Gleason score of 7 or 8 and a PSA of less than 20.
  • The cells are more abnormal than in the previous stage.

Stage 3A

  • The disease has not spread outside of the prostate.
  • The physician may not feel the tumor or view it on an imaging test.
  • There’s no cancer in the lymph nodes.
  • The patient has a Gleason score of 8 or less and a PSA of at least 20.

Stage 3B

  • Cancer has spread, but it’s not in the lymph nodes or far-reaching areas of the body.
  • The patient has a Gleason score of 8 or less and any PSA rating.

Stage 3C

  • Cancer has either spread outside the prostate or not.
  • There’s no cancer in the lymph nodes.
  • The patient has a Gleason score of 9 or 10 and any PSA rating.

Stage 4A

  • Cancer may have spread outside the prostate or not.
  • The cancer is in the lymph nodes but hasn’t spread to distant areas of the body.
  • The patient can have any Gleason or PSA score.

Stage 4B

  • Cancer may have developed in areas near the prostate or the lymph nodes
  • Cancer has spread to the bones, lymph nodes, or other organs.
  • The patient can have any Gleason or PSA score.

Frequently Asked Questions

Prevent prostate cancer

There’s evidence that following a poor diet high in fat, red meat, and dairy products may be one of the causes of prostate cancer, or at least connected to a higher likelihood of developing the condition.

According to the Prostate Cancer Foundation[3], the foods you should eat to support a healthy prostate gland include cruciferous vegetables, berries, fish, cooked tomatoes, coffee, and tea. Following this diet may help mitigate some of the prostate cancer risk factors.

Many of these foods are high in antioxidants, which can promote healing, strengthen the immune system, and combat some of the causes of prostate cancer. Many of them have anti-inflammatory benefits, which may reduce prostate swelling and decrease symptoms like a thin urine stream.

The most severe form of prostate cancer is stage 4, or the last of the prostate cancer stages. This means that cancer has spread outside the prostate and may proliferate in different parts of the body. Once this happens, the condition is considered to be fatal.

Generally speaking, you should be able to experience a full life after recovery from prostate cancer. However, some men do experience after-effects like erectile dysfunction and urinary incontinence that may even be permanent. So life after prostate cancer may require adjusting to a new normal.

The Final Word

Although a diagnosis of prostate cancer may be frightening, it’s important to remember that it responds very well to treatment. According to John Hopkins Medicine, in 80-85% of cases, the condition is found in the early stages of development, making the tumor easier to treat.

If you have not been diagnosed but have some prostate cancer risk factors, you must have regular screenings at least once a year to ensure early detection. This will enhance your chances of successful recovery.

As one of the causes of prostate cancer is genetics, men with a family history of prostate cancer especially a father and/or grandfather, are particularly encouraged to get checked and may want to do so more often than once a year after 40.

There are several types of prostate cancer, so your specific treatment plan will depend on which you are diagnosed with, and the level of advancement of your condition. Treatment and recovery from prostate cancer may not be easy, but it’s certainly possible.

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