Prostate Cancer Staging

As stated in my most recent post, I was told today that my Prostate Cancer Staging was: 'T3N0M0'. In order to put this in some perspective, for our readers; I decided to post the following:

The following article is excerpted from PSA Rising - Prostate Cancer Survivor (News, Info & Support) I would encourage all our readers to visit the author's website.


What is Staging?

If prostate cancer has been found by any method, the next step is to see how much of the prostate it takes up and whether it has spread outside the prostate to nearby tissue, lymph nodes, organs and/or bones.

This is called staging the cancer. Your prostate cancer stage is key to your treatment options. Primarily, staging is based on your digital rectal exam (DRE).


Two different systems of staging have been used for prostate cancer.

Today the older ABCD system has largely been replaced by the TNM (Tumor, Nodes, Metastases) system. In addition, two levels of staging are used, clinical and pathologic.

Clinical staging is based on digital exam and any further non-invasive tests necessary to find the extent of the cancer. It affects primary treatment decisions.

Pathologic stage refers to examination of the prostate and any other tissue removed during surgery. Only patients who undergo surgery receive the second level of staging.


The TNM system of staging

Primary tumor (T)

TX: Tumor cannot be assessed.

T1: Doctor is unable to feel the tumor or see it with imaging such as transrectal ultrasound.

T1a: Cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed.

T1b: Cancer is found after TURP and is present in more than 5% of the tissue removed.

T1c: Cancer is found by needle biopsy done because of an elevated PSA.

T2: Doctor can feel the tumor when a digital rectal exam (DRE) is performed but the tumor still appears to be confined to the prostate.

T2a: Cancer is found in one half or less of only one side (left or right) of the prostate.

T2b: Cancer is found in more than half of only one side (left or right) of the prostate.

T2c: Cancer is found in both sides of the prostate.

T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles.

T3a: Cancer extends outside the prostate but not to the seminal vesicles.

T3b: Cancer has spread to the seminal vesicles.

T4: Cancer has spread to tissues next to the prostate (other than the seminal vesicles), such as the sphincter, rectum and/or wall of the pelvis.

T4a: Invades bladder neck, external sphincter, or rectum.

T4b: Invades muscles and/or pelvic wall.


Regional Lymph Nodes (N)

To see if the cancer has spread to the lymph nodes or bones, the doctor may order a CT scan or an MRI of the pelvis and a bone scan.

Sentinel lymph nodes in the pelvis that look suspicious on CT scan or MRI can be examined by fine needle aspiration biopsy method. This is done commonly in breast cancer staging.

NX: Nodes cannot be assessed

N0: No regional node metastasis

N1: Single node metastasis, 2 centimeters (cm) or less at largest point

N2: Single node metastasis, 2 cm to 5 cm at largest point, or multiple nodes, no larger than 5 cm at largest point

N3: Metastasis larger than 5 cm in any node


Distant Metastasis (M)

MX: Metastasis cannot be assessed

M0: No distant metastasis

M1: Distant metastasis

M1a: Distant lymph node(s) involved

M1b: Bone(s) involved

M1c: Other site(s) involved (e.g. liver, lung)


Note on stages that "cannot be assessed."

Patients in whom abnormal digital rectal examinations (DREs) do not match up with their prostate biopsy findings are "clinically unstageable."

To find out what unstageable prostate cancer involves, Wisconsin researchers looked at post-op pathology reports of some 100 patients who were unstageable.

"For these patients pathological staging revealed pT2a cancers in 26%, pT2b in 53%, pT3a in 19%, pT3b and pT0 in 1% of patients." The authors conclude: "Thus, the prevalence of unstageable prostate cancer is low but significant and it can be accurately classified into clinical stage T1c. "Clinical and pathological characteristics of unstageable prostate cancer: analysis of the CaPSURE database. Langenstroer P et al. Medical College of Wisconsin. J Urol. 2005 Jul;174(1):118-20.

More on Staging

After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.

The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
  
  
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  
  
• Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.
  
  
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  
  
• Seminal vesicle biopsy: The removal of fluid from the seminal vesicles (glands that produce semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
  
  
  

The stage of the cancer is based on the results of the staging and diagnostic tests, including the original tumor biopsy. The biopsy is used to determine the Gleason score. The Gleason score ranges from 2-10 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread. The lower the number, the less likely the tumor is to spread.


The following stages are used for prostate cancer:

As prostate cancer progresses from Stage I to Stage IV, the cancer cells grow within the prostate, through the outer layer of the prostate into nearby tissue, and then to lymph nodes or other parts of the body.


Stage I

In stage I, cancer is found in the prostate only. It cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. The Gleason score is low. Stage I prostate cancer may also be called stage A1 prostate cancer.


Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.


Stage III

In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles. The Gleason score can range from 2-10. Stage III prostate cancer may also be called stage C prostate cancer.


Stage IV

In stage IV, cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones. The Gleason score can range from 2-10. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.

Staging Prostate Cancer

Updated to include a video of an MRI scan. Click on 'MRI' link in Regional Lymph Nodes (N).

The following article is excerpted from PSA Rising - Prostate Cancer Survivor (News, Info & Support) in the hope readers may become more informed. I would encourage all our readers to visit the author's website.


What is Staging?

If prostate cancer has been found by any method, the next step is to see how much of the prostate it takes up and whether it has spread outside the prostate to nearby tissue, lymph nodes, organs and/or bones.

This is called staging the cancer. Your prostate cancer stage is key to your treatment options. Primarily, staging is based on your digital rectal exam (DRE).


Two different systems of staging have been used for prostate cancer.

Today the older ABCD system has largely been replaced by the TNM (Tumor, Nodes, Metastases) system. In addition, two levels of staging are used, clinical and pathologic.

Clinical staging is based on digital exam and any further non-invasive tests necessary to find the extent of the cancer. It affects primary treatment decisions.

Pathologic stage refers to examination of the prostate and any other tissue removed during surgery. Only patients who undergo surgery receive the second level of staging.


The TNM system of staging

Primary tumor (T)

TX: Tumor cannot be assessed.

T1: Doctor is unable to feel the tumor or see it with imaging such as transrectal ultrasound.

T1a: Cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed.

T1b: Cancer is found after TURP and is present in more than 5% of the tissue removed.

T1c: Cancer is found by needle biopsy done because of an elevated PSA.

T2: Doctor can feel the tumor when a digital rectal exam (DRE) is performed but the tumor still appears to be confined to the prostate.

T2a: Cancer is found in one half or less of only one side (left or right) of the prostate.

T2b: Cancer is found in more than half of only one side (left or right) of the prostate.

T2c: Cancer is found in both sides of the prostate.

T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles.

T3a: Cancer extends outside the prostate but not to the seminal vesicles.

T3b: Cancer has spread to the seminal vesicles.

T4: Cancer has spread to tissues next to the prostate (other than the seminal vesicles), such as the sphincter, rectum and/or wall of the pelvis.

T4a: Invades bladder neck, external sphincter, or rectum.

T4b: Invades muscles and/or pelvic wall.


Regional Lymph Nodes (N)

To see if the cancer has spread to the lymph nodes or bones, the doctor may order a CT scan or an MRI of the pelvis and a bone scan.

Sentinel lymph nodes in the pelvis that look suspicious on CT scan or MRI can be examined by fine needle aspiration biopsy method. This is done commonly in breast cancer staging.

NX: Nodes cannot be assessed

N0: No regional node metastasis

N1: Single node metastasis, 2 centimeters (cm) or less at largest point

N2: Single node metastasis, 2 cm to 5 cm at largest point, or multiple nodes, no larger than 5 cm at largest point

N3: Metastasis larger than 5 cm in any node


Distant Metastasis (M)

MX: Metastasis cannot be assessed

M0: No distant metastasis

M1: Distant metastasis

M1a: Distant lymph node(s) involved

M1b: Bone(s) involved

M1c: Other site(s) involved (e.g. liver, lung)


Note on stages that "cannot be assessed."

Patients in whom abnormal digital rectal examinations (DREs) do not match up with their prostate biopsy findings are "clinically unstageable."

To find out what unstageable prostate cancer involves, Wisconsin researchers looked at post-op pathology reports of some 100 patients who were unstageable.

"For these patients pathological staging revealed pT2a cancers in 26%, pT2b in 53%, pT3a in 19%, pT3b and pT0 in 1% of patients." The authors conclude: "Thus, the prevalence of unstageable prostate cancer is low but significant and it can be accurately classified into clinical stage T1c. "Clinical and pathological characteristics of unstageable prostate cancer: analysis of the CaPSURE database. Langenstroer P et al. Medical College of Wisconsin. J Urol. 2005 Jul;174(1):118-20.