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An in-depth report on the causes, diagnosis, treatment, and prevention of prostate cancer.
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.
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 followed by numbers 0 through 4 refers to the size and extent of the tumor itself.
Stage, T1 - T4
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.
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.
The tumor extends through the prostate capsule.
The tumor is fixed to or invades adjacent structures.
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
Regional lymph nodes are still cancer-free.
A small tumor is in a single pelvic node.
A medium-size tumor is in one node, or small tumors are in several nodes.
A large tumor is in one or more nodes.
M stages refer to metastasis (tumors developing outside the prostate).
Metastasis has not occurred (cancer has not spread beyond the regional lymph nodes).
Cancer has spread to lymph nodes beyond the regional lymph nodes.
Cancer has invaded the bones.
Cancer has spread to other sites.
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:
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:
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