We never know what to expect in life, including our health outcomes. The tragic reality is that one in every eight men will receive a prostate cancer diagnosis. While most men know what prostate cancer is, they typically don’t have a clear understanding of the disease’s progression after diagnosis. Prostate cancer has four distinct stages. Each stage describes the changes the patient goes through as the cancer advances. Let’s give you a brief introduction to the four stages of prostate cancer and how medical professionals treat the disease.
Understanding Prostate Cancer Stages
How Medical Professionals Stage Prostate Cancer – The TNM System
Doctors use the TMN system for staging prostate cancer, meaning identifying the critical tipping points where the disease advances and requires a different approach to treatment and prognosis. The clinical stage is an estimate based on a physical exam, while an exam of the tissue determines the pathological stage.
“T” – Tumor Size & Extent
How big is the primary tumor, and what’s the extent of its spread into the prostate gland and surrounding tissues? The medical community classifies tumors into four categories. From “T1,” which are localized, non-palpable tumors, to “T4,” which have metastasized and spread.
“N” – Lymph Node Involvement
Is the cancer in the lymph nodes? Classifications in this category include “N0” signifying no regional lymph node involvement, and “N1” which represents the result of cancer being present in the regional lymph nodes.
“M” – Distant Metastasis
This evaluation metric shows data on whether the cancer has spread to other parts of the body. “M0” signifies no metastasis, while “M1” shows that there is metastasis of the cancer in other distant areas of the body.
The Four Stages of Prostate Cancer
Stage 1: The Importance of Early Detection and Initial Characteristics
Stage 1 prostate cancer is tough for the patient to detect. They might remain unaware of the issue for months or even years before symptoms present in the latter stages. It isn’t until they get a routine PSA screening that the doctor realizes they have elevated PSA (Prostate Specific Antigen) levels. Based on the results, cancer might be a risk.
Prostate cancer cells don’t grow aggressively, so it’s important to get an early diagnosis of the problem. The slow-growing nature of the cancer cells makes this possible, leading to vastly improved medical outcomes in the last few decades.
Stage 2: Tumor Growth & Understanding Treatments
Stage 2 prostate cancer involves the tumors growing larger, with more aggressive behavior. However, the growth and spread of cancer cells is still limited to the prostate gland itself.
Many patients remain asymptomatic at this stage, and early treatment options include:
- Active “watching and waiting,”
- Prostatectomy surgery
- Radiation and hormone therapy
The physician chooses the treatment based on the merits of the case.
Stage 3: Locally Advanced Prostate Cancer
In this stage, the cancer spreads to nearby tissues or seminal vesicles. However, despite its spread, it hasn’t reached remote regions of the body yet. Symptoms during stage 3 can include pain or discomfort when urinating.
Doctors use a combination of treatments with the focus of limiting the spread of cancer cells through:
- Hormone therapy
- Radiation
- Surgery
Stage 4: Metastatic Prostate Cancer
This critical stage of the disease means the cancer has spread to further regions of the body. Cancer may appear in the bladder, nearby lymph nodes, bones, or other organs and glands. This results in symptoms of pain, weight loss, frequent urination, and fatigue.
Medical interventions usually include systemic therapies like:
- Chemotherapy
- Hormone therapy
- Palliative care
At this stage of the disease, there’s not much physicians can do but manage symptoms and make the patient comfortable.
The Role of the Gleason Score in Medically Staging Prostate Cancer
Prostate cancer generally isn’t classified by the medical community as an aggressive form of cancer. Doctors use the Gleason Score to determine the aggressive nature of the disease and how it plays out in each patient.
The patient undergoes a biopsy which is analyzed for cancer cells, and pathologists rate the score on a scale of 2 to 10.
The Gleason Score consists of two parts, both contributing to the patient's total score. The first component is the primary grade, representing the most common cancer cell pattern, and the second indicates the most prevalent cell pattern. The practitioner then adds the score for the two grades to get the final Gleason Score.
Gleason scores lower than 6 show less aggressive forms of the disease, and scores of 8 or higher indicate an aggressive form of prostate cancer.
How Staging Affects Medical Treatment Decisions
Localized Cancer – Stages 1 & 2: The doctor tailors patients' treatment to their Gleason score and health. Choices include mindful waiting and watching, surgery (prostatectomy), or radiation therapy.
Locally Advanced Cancer – Stage 3: Doctors take a more aggressive approach to treating this stage of the disease. Patients can expect to undergo a multi-modal treatment approach combining hormone and radiation therapy and/or surgery.
Metastatic Cancer – Stage 4: Targeted therapies like chemotherapy and surgery become critical at this stage. The doctors focus on improving the patient’s quality of life as the disease progresses.
Understanding the Risk of Prostate Cancer Recurrence
If you have a higher Gleason Score or if you get a late diagnosis, you’re at higher risk of experiencing reoccurrence of the disease. You’ll need to carefully monitor your PSA levels through yearly screening to ensure they don’t recur.
Those patients who have a family history of the disease are also at a higher risk of the cancer returning. However, since most prostate cancers are slow-moving in the body, it’s become much easier for the medical community to spot the disease earlier and get patients the treatment they need to beat the disease.
ADULT PEDIATRIC UROLOGY & UROGYNECOLOGY
The attentive, compassionate physicians, providers, and staff at Adult Pediatric Urology & Urogynecology are committed to providing innovative, quality patient care in our state-of-the-art facility.
From screening and prevention to treatment and recovery, our health professionals will be there for you. Our team of dedicated physicians has been serving residents of Nebraska, Iowa, and South Dakota for more than 25 years.
