Prostate Cancer Diagnosis Workup
Once prostate cancer has been found, more tests
will be done to determine the level of malignancy
(the grade of the cancer) and to find out if the
cancer has spread (or metastasized) from the prostate
to other parts
of the body (the staging of the cancer). To plan
treatment, a doctor needs to know (1) whether the
cancer has spread, as well as (2) the grade and
(3) the stage
of the disease. The following grades and stages are
used for prostate cancer.
Determining Whether the Cancer has Metastasized
There are several tests that can help determine
whether the cancer has spread beyond the prostate
to other parts of the body, including:
A bone scan may show areas of rapid bone growth that
can be associated with cancer. Prostate cancer, when
it spreads to the skeleton, typically has a classic
pattern of random and variable hot spots that
show up on the scan. These patterns frequently
occur along the spine, ribs and skull. The lack of
these patterns does not, however, rule out the spread of
the cancer. If the patterns are not visible on the
scan, it may only mean that there are no cancer spots
in the skeleton large enough to be detected by the
CT Scan (also called CAT Scan)
A CT scan (or CAT scan), which stands for
computerized axial tomography, uses computerized
X-ray pictures to evaluate internal organs of the
body. The CT scan is most often used prior to
administering radiation therapy (discussed further
in order to help calculate how much radiation and
where exactly in the body the radiation should be
Grading of the Prostate Cancer
The malignancy (or aggressiveness) of the prostate
cancer is documented by assigning a grade
to the cancer based upon the appearance of the
cancer cells and how they are arranged together.
The Gleason scale is a standard grading system
which assigns cancer cells a score from 1 to 10.
These scores are broken down into three main levels:
low-grade cancer: have a Gleason score of not
more than 4. This is the least-aggressive type
of cancer. Cells from low-grade prostate cancer
have an appearance most like normal cells, and
tend to be slow-growing. Such cancer cells are
intermediate-grade cancer: have a Gleason score
between 4 and 7. By the time the cancer has
become intermediate-grade, it has turned more
aggressive than a low-grade cancer.
Intermediate-grade cancer cells have an
appearance that is less like normal cells and
is often faster growing than low-grade cancer
cells. Such cells are called
high-grade level: have a Gleason score between
8 and 10. This is the most aggressive type of
cancer. Cells from high-grade prostate cancer
are the least like normal prostate cells. They
are rapid-growing and highly aggressive, often
spreading into the lymph nodes and bone. Such
cells are called
The higher the grade of the cancer, the more
difficult it is to successfully treat the cancer.
The risk of dying from prostate cancer increases
substantially for men who are diagnosed with
high-grade (or poorly-differentiated) prostate
Staging of the Prostate Cancer
The following stages are used for prostate cancer.
Stage T1 (Stages A and B)
The tumor is located only within the prostate and
has not spread to other parts of the body. At this
stage, prostate cancer does not cause any symptoms.
The tumor is too small to be felt during a DRE and
cannot be seen on an imaging scan. These tumors
will most likely only be found during follow-up
of screening tests showing abnormal PSA levels.
Stage T1a (A1):
The tumor is incidentally found to be in 5% or
less of a prostate tissue sample.
Stage T1b (A2):
The tumor is incidentally found to be in more
than 5% of a prostate tissue sample.
Stage T1c (B0): The tumor is identified by a
needle biopsy as a follow-up of screening tests
showing an elevated PSA result.
Stage T2 (Stage B)
The tumor is STILL located only within the prostate
and has not yet spread to other parts of the body,
but is now large enough to be felt during a DRE.
Men who have Stage T2 often do not experience any
The tumor involves less than half of one lobe
of the prostate. The tumor can usually be felt
and is often discovered during a DRE exam.
Stage T2b (B1):
The tumor involves more than half of one lobe
of the prostate and can usually be felt during
a DRE exam.
Stage T2c (B2):
The tumor involves both lobes (the left
and the right) of the prostate and is felt
during a DRE exam.
Stage T3 (Stage C)
The tumor has spread to outside of the prostate into
immediately surrounding tissue, possibly including
the seminal vesicles.
Stage T3a (C1):
The tumor has spread to outside of the prostate
on only one side.
Stage T3b (C2):
The tumor has spread to outside of the prostate
on both sides.
Stage T3c (C3):
The tumor has spread to one or both of the
Stage T4 (No equivalent in A, B, C, D system)
The tumor is still within the pelvic region but
may have spread to other areas.
The tumor has spread beyond the prostate to any
or all of the bladder neck, the external
sphincter, and/or the rectum.
The tumor has spread beyond the prostate and
now may affect the levator muscles (the muscles
that help to raise and lower the organ) and/or
the tumor may be attached to the pelvic wall.
N Staging (Stage D)
No metastasis to regional lymph nodes.
Stage N1: (Stage D1)
Prostate cancer cells have metastasized
to a single lymph node in the pelvic area and
are 2 cm (approximately 3/4 of one inch) or
less in size.
Stage N2: (stage D1)
Prostate cancer cells have metastasized (spread)
either to a single lymph node and are more than
2 cm but less than 5 cm (approximately 2 inches)
in size, or the prostate cancer cells are found
in more than one lymph node and are no larger
than 5 cm in size.
Prostate cancer cells have metastasized to the
lymph nodes and are larger than 5 cm in size.
M Staging (Stage D)
No distant metastasized.
Stage M1: (Stage D2)
The prostate cancer cells have metastasized (spread)
beyond the pelvic area to other parts of the body,
which can include the spinal column. Bone pain,
weight loss, and tiredness are common symptoms.
Generally, Stage III (Stage C) and Stage IV (Stage D) are
sdvanced prostate cancer.
Once the diagnosis and workup are completed, a
plan can be developed.
Law Office of Joseph A. Hernandez, P.C.
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