Stages and Grade of Prostate Cancer
Early-stage disease
Men with early-stage prostate cancer (T1 or T2, see below) often have no detectable symptoms related to their prostate cancer. Men with an enlarged prostate can have urinary symptoms (frequency or slowstreams) that are usually not caused by their prostate cancer.
Advanced disease
Urinary symptoms can be a sign of locally advanced prostate cancer. A few men with locally advanced disease present with hematuria, urinary tract infections, and irritative voiding symptoms secondary to bladder outlet obstruction.
Rarely, men with metastatic prostate cancer can develop bone pain or leg swelling, weakness or (rarely) paralysis.
Metastatic spread
Adenocarcinoma of the prostate may spread locally through direct extension into periprostatic fat or via the ejaculatory ducts into seminal vesicles; lymphatically to regional lymph nodes, including the hypogastric and obturator lymph nodes; and to bone. The most common sites of bony metastases are the lumbosacral spine, but any bone, including the skull and ribs, can be involved. Rare sites of metastatic spread include the liver and lungs.
The Gleason Score: A Measure of Prostate Cancer Aggressiveness/Invasiveness
Adenocarcinomas make up the vast majority of prostate cancers. The grading system developed by Gleason is the predominant way to measure prostate cancer aggressiveness. The Gleason score is determined by how abnormal the cancer cells appear under the microscope. The Gleason scoring system assigns a number from four to ten for each cancer, with a higher score indicating more invasive cancers.
Other tumor types
Cancers, other than adenocarcinomas, are relatively rare and include ductal adenocarcinoma, mucinous adenocarcinoma, transitional carcinoma or small cell cancer.
Staging Systems
"Staging systems are used to describe how much cancer a patient has. The most widely used and universally accepted staging system for prostate cancer is the TNM system. The previously used Whitmore system is used less frequently.
In the TNM system, T1 and T2 tumors are confined to the prostate itself, whereas T3 and T4 tumors have extended beyond the prostate.
Stages of Prostate Cancer
The TNM (Tumor, Nodes, Metastases) system, gauges the severity of cancer on an escalating scale.
Adapted from Fleming ID, Cooper JS. Hensen DE,et al (eds): AJCC Cancer Staging Manual, 5th ed. Philadelphia, Lippincott-Raven, 1998.
To learn more about the doctors that comprise the Prostate Care Center team, click here.
Portions of these web pages are based in part on content originally developed by Drs. M. Sanda, N. Shah, K. Pienta and others for the website of the University of Michigan Comprehensive Cancer Center. They are based in part on Cancer Management: A Multidisciplinary Approach: Medical, Surgical and Radiation Oncology, chapter 17, "Prostate Cancer," by K. Pienta, MD, H. Sandler, MD, N. Shah, DO, and M. Sanda, MD. Published by PRR: Melville, NY, 2002.
