After a prostate cancer diagnosis, your doctor will need to determine the extent of the prostate cancer and whether it has spread to other parts of the body. This process is known as staging. Understanding the stage of your prostate cancer will help your oncologist determine what timing and appropriate course of prostate cancer treatment that will benefit you the most.
There are two types of staging categories for prostate cancer: clinical staging and pathological staging. Clinical staging is based upon the results of your physical exam, including the digital rectal exam (DRE), imaging tests, prostate-specific antigen (PSA) testing, and Gleason score. Pathological staging is based on information found in prostate tissue after a biopsy or a surgical procedure.
Prostate cancer that spreads is usually first found in groin-area lymph nodes. If cancer has reached these nodes, it may also have spread further to other lymph nodes, bones, or organs. When prostate cancer has reached other parts of the body, it is still considered prostate cancer and is treated as such. This is also referred to as metastatic prostate cancer.
In addition to factors such as the size of the tumor, lymph node involvement, and if cancer has spread, grade grouping and PSA levels are used to determine the overall prostate cancer stage.
Prostate cancer is given one of five grades that are related to the Gleason score assigned by the pathologist who reviewed the samples taken during the biopsy. This score is based on how much the biopsied cancer looks like healthy tissue when viewed under a microscope.
Tissues that look healthier are considered slow-growing and are given a lower grade. They may be referred to as “well differentiated.” Tissues that look unhealthy are considered more aggressive and are given a higher grade. These are often called “poorly differentiated.”
Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist will look at the two most predominant cell patterns found in the sample. The more abnormal the cells appear, the higher the score on a scale of 1 to 5. These two numbers are added together to produce the Gleason score.
At prostate cancer stages 1 through 3, the oncologist considers if the result of the PSA test was above 10 but below 20 (medium) or above 20 (high). With prostate cancer stage 4, the PSA level doesn't impact the treatment options that will be recommended as much because the cancer has moved outside of the prostate.
The tumor is more advanced, with a higher grade than Stage I, but is still contained within the prostate. It may be big enough to be felt during a digital rectal exam or seen on a sonogram.
The tumor has spread beyond the prostate. It may have invaded the seminal vesicles but has not yet reached the lymph nodes.
Cancer has spread past the prostate and may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or other parts of the body.
Prostate cancer that comes back after treatment is called recurrent prostate cancer. Sometimes, this cancer returns to the prostate area. Other times, however, it can come back in other parts of the body. If your cancer does return, your doctor will schedule another round of tests to learn about the extent of the recurrence. These tests and scans will likely be similar to the ones that were done at the initial diagnosis of your prostate cancer.
If you or a loved one have been newly diagnosed with prostate cancer, the oncologists at Compass Oncology are ready to guide you through this journey. We provide patients in the Portland, OR, and Vancouver, WA areas the latest prostate cancer treatment options based on your unique situation. Request an appointment with one of our oncologists to discuss treatment plans for prostate cancer.