Prostate cancer is a malignant disease which occurs when cells in the prostate start to grow out of control. To determine the stage of the prostate cancer, physicians evaluate the extent of the primary tumor (T category), whether the cancer has spread to nearby lymph nodes (N category), the absence or presence of distant metastasis (M category), the PSA level at the time of diagnosis, and the Gleason score based on the prostate biopsy (or surgery).
“There are actually 2 types of staging for prostate cancer,” explains the American Cancer Society. “The clinical stage is your doctor’s best estimate of the extent of your disease, based on the results of the physical exam (including DRE), lab tests, prostate biopsy, and any imaging tests you have had. If you have surgery, your doctors can also determine the pathologic stage, which is based on the surgery and examination of the removed tissue. This means that if you have surgery, the stage of your cancer might actually change afterward.”
Prostate cancer stages are:
- Stage I: Stage I prostate cancer is the equivalent of T1 or T2a, which refers to a tumor which cannot be felt or seen with imaging, or cancer that is in one half or less of only one side (left or right) of the prostate. The cancer is still within the prostate and has not spread to any nearby lymph nodes (N0 and M0), the Gleason score is under six, and the PSA under 10.
- Stage IIA: Refers to N0 and M0 as well. In the case of T1, the Gleason score is seven and the PSA level under 20, or the Gleason score is under six and the PSA is between 10 and 20. In the case of T2a or T2b, which means the cancer is in one half or more of only one side (left or right) of the prostate, the Gleason score is seven or less and the PSA level lower than 20.
- Stage IIB: Refers to three different situations. The first is T2c, which means the tumor can be felt by a digital rectal exam or seen with imaging such as transrectal ultrasound and is in both sides of the prostate, as well as N0, M0, any Gleason score, and any PSA. It also applies to T1 or T2, N0, M0, any Gleason score, and PSA of 20 or more, or either T1 or T2, N0, M0, Gleason score of 8 or higher, and any PSA.
- Stage III: Is diagnosed when “the cancer has grown outside the prostate and may have spread to the seminal vesicles [T3], but it has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor can have any Gleason score and the PSA can be any value.”
- Stage IV: Refers to cancer which has grown into tissues next to the prostate, other than the seminal vesicles, including the urethral sphincter, rectum, bladder, and/or the wall of the pelvis (T4), as well as N0, M0, any Gleason score, and any PSA. Other situations which are stage IV prostate cancer include any T, M0, any Gleason score, any PSA, and N1, the equivalent to cancer spread to nearby lymph nodes, or any T, any N, any Gleason score, any PSA, and M1, which means the cancer has spread to other, more distant parts of the body.
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