Staging
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Stages of Prostate Cancer:

One of the most useful ways to diagnose cancer is understanding the stages that it is in. This helps a cancer team how describe and treat the different stages of cancer. There are two types of staging that exists for prostate cancer.

  1. Clinical stage. The clinical stage is the best estimate of the prostate cancer by your doctor. This is based on the results of your physical exams (like the DRE), your prostate biopsy, lab tests, and any other imaging tests you may have had.
  2. Pathologic stage. If you have received any surgery for prostate cancer, doctors will determine the pathologic stage the cancer is at. This is based on the examination and removal of tissue. This type of staging is supposed to be more accurate than clinical staging because doctors are able to get a firsthand impression of prostate cancer.

With these two ways of staging, doctors then determine what stage your cancer is at. This is done by using a grading system.

The most used stage system is the American Joint Committee on Cancer (AJCC) TNM grading system.

The grading system is graded on 5 pieces of information:

  1. T: The area of the primary tumor
  2. N: If the cancer has spread to the nearby lymph nodes
  3. M: Presence or absence of metastasis
  4. PSA level of the time of diagnosis
  5. Gleason score

T Categories (clinical)

There are 4 categories within the T category to describe the extent of prostate tumor.

  • T1: The doctor cannot feel the tumor or see it with imaging.
  • T2: Doctor can feel the cancer with a digital rectal exam (DRE)
  • T3: Cancer has grown and spread outside the
  • T4: Cancer has grown into tissues next to the prostate.

N Categories

These categories describe if the cancer has spread to regional lymph nodes.

  • NX: Nearby lymph nodes were not assessed.
  • N0: Caner has not spread to nearby lymph nodes.
  • N1: Cancer has spread to one or more lymph nodes in the pelvis.

M Categories

These categories describe if the cancer has spread to other distant parts of the body.

  • M0: Cancer has not spread past lymph nodes.
  • M1: Cancer has spread past lymph nodes.

Whitmore-Jewett System

This has been another popular way to stage prostate cancer. This is graded on an A, B, C, or D method. However, most specialists now use the TMN system. If the doctor you are seeing uses the Whitmore-Jewett system, do not be afraid to ask them to convert this to the more used TNM grading system.

Always ask your doctor to explain your stages. It is important to understand about your treatment options.

 

PSA HISTORY

The pattern of your PSA history can be an important factor for evaluating your risk. Start by reviewing your records and making a list of all PSA values and dates. For an extensive discussion of this topic, see the fifth section, “The Use the PSA and Derivative Tools in Diagnosis and Staging” of our Insights articles “What We Should Have Learned about PC in the Last 10 Years – Part Three

The following concepts were discussed under PSA Blood Test

 

PSA Doubling Time (PSADT)

PSADT can provide an indication of risk of progression. Egawa et al[1] examined PSADT before radical prostatectomy and found that a doubling time of 3 years or less was more common with disease that was not organ-confined at radical prostatectomy. Also, in a watchful-waiting cohort, McLaren et al[2] found that approximately 50% of patients with a PSADT of <18 months progressed within 6 months. You can calculate your PSA doubling time using one of the calculators below, and recalculate with each new PSA test.

 

PSA Velocity (PSAV)

An increase of PSA > 2 ng/ml in one year is a high risk factor. D’Amico et al.[3] reported that a rise in PSA of more than 2 ng/mL/y before surgery identified patients at greater risk for prostate cancer mortality at 7 years. No patients whose PSA increased less than 2.0 ng/mL/y before surgery died of the disease at 7 years. Berger et al.[4] study also showed that in men eventually diagnosed with PC, the PSAV starts to increase in the six-year period prior to diagnosis.

 

PSA Density (PSAD)

PSAD is a calculation of the PSA value divided by the gland volume (in cubic centimeters) from ultrasound (or prostatectomy). Saidi et al[5] reported organ-confined disease for PSAD <0.2 = 76% vs. PSAD >0.2 = 47%. Radwan et al[6] concluded that PSAD is a strong predictor of advanced pathologic features and biochemical failure after radical prostatectomy.