Prostate Cancer (cont.)
How is the staging of
prostate cancer done?
The staging of a cancer refers to determining the extent
of the disease. Once a prostate cancer is diagnosed on a biopsy, additional
tests are done to assess whether the cancer has spread beyond the gland. For
this assessment, biopsies of the surrounding organs, such as the rectum or
urinary bladder, or of the nearby (pelvic) lymph nodes might be done. In
addition, imaging tests are usually performed. For example, radionuclide bone
scans can determine if there is a spread of the tumor to the bones.
Additionally, CAT scans (coaxial tomography) and MRIs (magnetic resonance
imaging) can determine if the cancer has spread to adjacent tissues or organs
such as the bladder or rectum or to other parts of the body such as the liver
or lungs. Newer scanning using a method called PET scan can sometimes help to detect hidden locations of cancer that has spread to various areas of the body.
In brief, doctors do the staging of prostate cancer based
primarily on the results of the prostate biopsy, possibly other biopsies, and
imaging tests. In staging a cancer, doctors assign various letters and numbers
to the cancer, depending on which of the classifications for staging they use.
The numbers and letters in the different classifications define the volume or
amount of the tumor and the spread of the cancer. The stage of the prostate
cancer, therefore, helps to predict the expected course of the disease and
determine the choice of treatment.
Two main systems are used to stage prostate cancer. In the
American urologic staging system, stage A describes a minimal cancer that can
neither be palpated (felt) on physical examination nor seen by imaging
techniques. Such a tumor is so small that it can be detected only by viewing it
under a microscope. Stage B refers to a larger cancer that may be palpated, but
that still is confined (localized) to the prostate gland. Stage C indicates
local spread beyond the prostate into the surrounding tissues. Stage D1
signifies a spread to the nearby (pelvic) lymph nodes and D2 is for distant
spread (metastasis), for example, to the bones, liver, or lungs.
The other main system for staging prostate cancer is
called the tumor, nodes, and metastasis (TNM)
classification. In this system, T1 and T2 are equivalent to stage A and B
(respectively) in the American urologic system. T3 describes cancer that
extends just beyond the capsule (coat) of the prostate, and T4 describes cancer
that is fixed to the surrounding tissues. N1 is equivalent to Stage D1 and M1
is equivalent to D2.
Next: What about surgical treatment for prostate cancer? »
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