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Prostate cancer staging

Staging is a term that is used to describe if a cancer has spread from where it first began. Prostate cancer staging is commonly described as:

  • Localized prostate cancer: the cancer is contained within the prostate gland and has not spread nearby tissues or elsewhere in the body.
  • Locally advanced prostate cancer: the cancer has spread outside the prostate gland to surrounding tissue, most often the seminal vesicles.
  • Advanced prostate cancer: the cancer has spread to nearby lymph nodes, bones, or elsewhere in the body.

How Is Staging Done?

Most of the time, tests such as an MRI scan or a CT scan are not very good at telling your doctor how much prostate cancer is present or whether it has spread.

Rarely, your doctor can feel a prostate cancer during a rectal exam. Sometimes a test called a bone scan will be done to see if the cancer has spread to your bones (a common place for the cancer to go).

However, your doctor will also use other information, to help guide treatment and follow-up and give you some idea of what to expect in the future. Other information includes:

  • PSA levels (and related tests)
  • Prostate biopsy results may be able to show how many areas of the prostate gland has cancer.
  • The Gleason score or grade, which comes from the results of your prostate biopsy, tells how aggressive the prostate cancer might be. Two areas of the tumor are graded on a scale of 1 – 5. The sum of the two grades is the overall Gleason score. This tells your doctor information about how different the prostate cancer cells are from normal tissue. The higher the score, the more different the cancer cells are from normal, and therefore, the more aggressive the cancer is

How Is Staging Used?

It is important to understand that only if and when you have surgery to remove the prostate gland can you and your doctor know for certain what the stage of your prostate cancer is.

However, using your symptoms, physical exam, and results of tests described just above, your doctors will often have a pretty good idea which stage of prostate cancer you have.

References

Antonarakis ES, Eisenberger MA. Expanding treatment options for metastatic prostate cancer. N Engl J Med. 2011 May 26;364(21):2055-8.

Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148(6):435-448.

Prostate Cancer Treatment (PDQ®) Last Modified: 06/01/2011

Update Date: 9/27/2011

Updated by: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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