Prostate cancer is a tumor that is found in older men which may be cured if it is localized and which responds to treatment if it has spread further. The growth of the tumor can vary from slow to quite rapid and some men have survived long after the cancer has metastasized to the bone. It is wise to discuss every aspect of treatments and therapies with your doctor so that you have all the information you need regarding the types of treatments and side effects/complications etc, before you choose your treatment.
Stages 1 and 2:
Patients with prostate stages 1 and 2 have a disease that is localized. The Gleason Pathologic Grade Test can predict if there will be penetration of the prostate gland capsule, invasion of the seminal vesicle or even spreading of the cancer to lymph nodes situated nearby. TRUS (Transrectal Ultrasound) facilitates the diagnosis by needle biopsy but the ultrasound cannot assess the size of the lymph node. CT (Computed Tomography) detects nodes that are enlarged but is not reliable for the pelvic node staging as compared to staging that is surgical. MRI is used to detect prostate cancer extra capsular extensions. Both the Ultrasound and the MRI can reduce understaging and improves the selection for therapy that is localized.
Two commonly used systems for cancer stages/staging:
o The Jewett system
The Jewett System has stages A to D. Stage A is a tumor that is not detectable clinically and is localized to the prostate gland. Stage B is a tumor that is confined to the prostate gland; Stage C is a tumor that is localized to the periprostatic area but has extended through the capsule and may involve the seminal vesicles. Stage D is when the cancer has mestastasized.
o The TNM System.
Also known as the Tumor, Node, Metastasis, the TNM is helpful in ascertaining the size of the tumor and to check if there are any lymph nodes containing cancer cells. This system is also used to check if the cancer has spread to other parts of the body. This system primarily uses numbers to accurately describe the stage of the cancer.
The ‘T’ is in the range of 1 to 4, with 1 being a small tumor and 4 being a large tumor.
‘N’ is measured in the range of 0 to 3, in this 0 indicates no positive lymph nodes and 3 means many lymph nodes.
‘M’ can be either 0 or 1, 0 indicates that the cancer is localized and not spread while ‘1’ means that it has conclusively spread.
Stage 3 and 4 Cancer:
This stage is also defined by the Jewett Staging System and the American Joint Committee on Cancer’s TNM classification system T3, NO; MO and G. EBRT (External Beam radiation Therapy). Hormonal therapy in combination with radiation therapy should be used for patients who do not have co-morbidities that are severe. Since most Stage 3 patients have symptoms that are urinary related, radiation therapy, transurethral resection of the prostate, radical surgery and hormonal manipulation should be considered in the treatment process.
A primary therapy used in stages 3 and 4 is androgen suppression with hormonal therapy which is given continuously to the patient. Clinical trials for prostate cancer stages 3 and 4 include Cryosurgery which is still under clinical evaluation. This technique involves the freezing of the tissue followed by thawing to destroy the cancer cells. Treatment selection for prostate cancer stages will depend on the age of the patient, present medical illnesses, other symptoms and the presence of bone metastases or lymph node involvement.
Early cancer stages:
These refer to the cancer that is entirely contained in the prostate gland itself and has not spread either to the distant body parts or to surrounding tissues and bone. This type of cancer is most curable and called a low-risk disease. The basic options for the early prostate cancer stages are:
o Radiation therapy: either radioactive seeding or EBR (External Beam Radiation)
o Active Surveillance: also known as watchful waiting or expectant management.