Tests Show A Certain Prostate Cancer Stage

When the doctor tells you that you have cancer it is scary enough, but when he says prostate cancer it is especially painful. Then the doctor starts to talk about cancer stages and treatments and your mind goes numb. It is only after you walk out the door that your mind starts to think and ask questions. One of the first ones to pop into your mind is just exactly what did he mean when he told me what stage my cancer was in?
Prostate cancer is one of the most common cancers in the United States, even though it can only affect half of the population. In most cases it is a slow growing, easily treatable cancer with a very good prognosis if caught early. Digital Rectal Exams (DRE) and Prostate Specific Antibody (PSA) tests are very good at detecting the cancer early if they are done annually starting at age 50 or age 40 for African-Americans or men with close relatives that have had the disease. This means that it is important to know if the disease has progressed to a certain prostate cancer stage.

Once your oncologist has confirmed that you have prostate cancer he is going to start talking to you about your disease reaching a certain prostate cancer stage. In essence he is telling you about how early the disease was caught in its progression. This is important because it determines what types of treatment will be available and ultimately what your chances of surviving the cancer are. Beyond a certain prostate cancer stage there is little your oncologist can do for your survival.

There are three different methods of describing the stage that your cancer is in; the National Cancer Institute system (Stage I, II, III, or IV), the Whitmore-Jewett System (A, B, C or D), and the TMN system (T1, T2, T3, T4, N+, M+). Each uses slightly different criteria to describe the progression of the cancer, but they generally track each other fairly well.

The earliest stage (I, A, or T1) is defined as a tumor that is detectable by PSA but not DRE or ultrasound. The tumor is microscopic in size. This is the earliest stage and the one with the best long term prognosis. Doctors want to catch prostate cancer at this stage as it gives them the most treatment options.

The next stage in the progression of the disease (II, B, or T2) is marked by the tumor having become large enough to be found by DRE, ultrasound, or needle biopsy done because of a high PSA test result. The disease is still very treatable and the long term prognosis remains very good.

The next stage marks the start of the spread of the disease (III, C, or T3) to surrounding tissues beyond the prostate, but not to the lymph nodes. Seminal vessels are usually affected in this stage. The doctor’s options for treatment are now starting to be limited and the prognosis for full recovery is starting to decline.

The next stage is described separately only in the TMN (T4) system and would still be included in the earlier stage in the other two systems. The cancer has now spread to the bladder, but not to the lymph system. Surgical interventions are much more complicated and the long term prognosis continues to decline.

The final stage in two of the systems (IV or D) marks the spread of the cancer to the lymph system and beyond. The TMN system divides this stage into two; M+ marking the spread to the pelvic lymph nodes and N+ to the more distant lymph nodes, organs or bones. N+ marks that final, certain prostate cancer stage where treatment is generally palliative with virtually no long term prognosis.

In the early stages of the disease there are many treatments available for prostate cancer, but beyond a certain prostate cancer stage there are currently no practical cures or treatments. This means that early detection, as with all cancers, is the key to survival.
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