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Prostate cancer - Staging and Grading
- Highlights
- Introduction
- Risk Factors
- Prognosis
- Symptoms
- Diagnosis
- Staging and Grading
- Treatment
- Active Surveillance (Watchful Waiting)
- Surgery
- Radiation Therapy
- Hormone Therapy and Chemotherapy
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of prostate cancer.
Staging and Grading:
Staging and Grading
A pathologist will read the biopsy report and assign a grade to the tumor cells. The Gleason system classifies and scores the cancers cells based on their microscopic appearance. Based on the grade, PSA test, digital rectal exam, and possibly imaging tests, the doctor stages the cancer. Staging refers to how far the cancer has spread. The stage and grade of cancer can help the doctor advise on treatment options.
TNM Staging System
A tumor's stage is an indication of how far it has spread from its original site. Cancers are staged according to whether they are still localized (still within the prostate gland) or have spread beyond the original site. The current prostate cancer staging system is the TNM system.
The TNM system refers to clinical tumor stages as:
- T for tumor
- N for regional lymph nodes
- M for metastasis (tumors developing outside the prostate)
T Stages
T followed by numbers 0 through 4 refers to the size and extent of the tumor itself.
Stage, T1 - T4 | Description |
T1 | The tumor cannot be felt or seen using imaging techniques. |
T1a. Cancer cells are incidentally found in 5% or less of tissue samples from prostate surgery unrelated to cancer. | |
T1b. Cancer cells found in more than 5% of samples. | |
T1c. Cancer cells identified by needle biopsy, which is performed because of high PSA levels. | |
T2 | The cancer is confined to the prostate but can be felt as a small well-defined nodule. |
T2a. Tumors are in half a prostate lobe. | |
T2b. Tumors are in more than half a lobe. | |
T2c. Tumors in both lobes. | |
T3 | The tumor extends through the prostate capsule. |
T4 | The tumor is fixed to or invades adjacent structures. |
N Stages
N followed by 0 through 3 refers to whether the cancer has reached the regional lymph nodes, which are located next to the prostate in the pelvic region.
Stage, N0 - N3 | Description |
N0 | Regional lymph nodes are still cancer-free. |
N1 | A small tumor is in a single pelvic node. |
N2 | A medium-size tumor is in one node, or small tumors are in several nodes. |
N3 | A large tumor is in one or more nodes. |
M Stages
M stages refer to metastasis (tumors developing outside the prostate).
Stage | Description |
M0 | Metastasis has not occurred (cancer has not spread beyond the regional lymph nodes). |
M1a | Cancer has spread to lymph nodes beyond the regional lymph nodes. |
M1b | Cancer has invaded the bones. |
M1c | Cancer has spread to other sites. |
The Gleason Grading System
Tumors are assigned scores according to a scale known as the Gleason system, which measure how well or how poorly organized the cancer cells are under the microscope. The first step is to grade the tumors:
- Grade 1: Single, well-packed tumors
- Grade 2: Single, more loosely arranged and less uniform tumors
- Grade 3: Single tumors of different sizes and patterns, with cellular breakdown becoming increasingly worse
- Grade 4: Irregular tumor masses, fused together; may show clear cells
- Grade 5: The tumors have broken down and cellular structure has markedly deteriorated
Two-thirds of prostate cancers have a mix of tumor grades. To determine a prognosis, two numbers are assigned, representing the dominant grade and then the minor grade. The cancer is then "scored" by adding the dominant grade plus the minor grade. For example, a tumor with a dominant grade of 3 and a minor grade of 4 are given a Gleason score of 7. The following scores are often used to suggest how well or poorly the tumor is differentiated. The higher the score, the more severe the break-down of their cellular structure and the more likely they are to spread aggressively:
- Score 2 - 4: Well-differentiated. Indicates about a 95% chance for surviving 15 years without aggressive treatment.
- Score 5 - 6: Moderately well differentiated. Slightly lower chance of survival that decreases with time.
- Score 7 - 10: Moderately poorly to poorly differentiated, with 15-year survival rates of 15 - 40%.
Resources
- www.cancer.gov -- National Cancer Institute
- www.cancer.org -- American Cancer Society
- www.asco.org -- American Society of Clinical Oncology
- www.cancer.net/portal/site/patient -- Cancer.Net
- www.prostatecancerfoundation.org -- Prostate Cancer Foundation
- www.urologyhealth.org -- Urology Health
- www.nccn.org -- National Comprehensive Cancer Network
- www.cdc.gov/cancer/prostate -- CDC Cancer Prevention and Control
- www.psa-rising.com -- PSA Rising: Prostate Cancer Survivor Info
- www.ustoo.org -- Us Too! Prostate Cancer Education and Support
- www.cancer.gov/clinicaltrials -- Find clinical trials
- www.zerocancer.org -- Zero -- The Project to End Prostate Cancer
References
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Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol. 2008 Nov;180(5):1993-2004. Epub 2008 Sep 25.
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- Reviewed last on: 8/5/2009
- Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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