Prostate cancer is a disease
that develops in the male
prostate gland (part of the male
reproductive system). It usually
affects men over the age of 50
and is more prevalent in the
United States than other
countries around the world (such
as South and East Asia ). In
the USA it is the most common
type of cancer in men - only
second to lung cancer.
Symptoms:
There are very few early
symptoms. When Symptoms are
present they usually manifest
themselves as:
-
frequent urination,
-
increased urination at
night,
-
difficulty beginning and
maintaining a steady stream
of urine,
-
blood in the urine,
-
painful urination
-
difficulty achieving
erection
-
painful ejaculation
Treatment
Treatment of prostate cancer
depends on a number of factors
such as age and health of the
patient, as well as the stage
(see below) of the tumour.
Typically treatment may occur
with any one (or combination) of
the following
-
surgery
-
radiation
-
hormonal therapy
-
chemotherapy
-
proton therapy
-
cryosurgery
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Staging:
Evaluation of the (primary)
tumour ('T')
-
TX: cannot evaluate the
primary tumour
-
T0: no evidence of tumour
-
T1: tumour present, but not
detectable clinically or
with imaging
-
T1a: tumour was incidentally
found in less than 5% of
prostate tissue resected
(for other reasons)
-
T1b: tumour was incidentally
found in greater than 5% of
prostate tissue resected
-
T1c: tumour was found in a
needle biopsy performed due
to an elevated serum PSA
-
T2: the tumour can be felt
(palpated) on examination,
but has not spread outside
the prostate
-
T2a: the tumour is in half
or less than half of one of
the prostate gland's two
lobes
-
T2b: the tumour is in more
than half of one lobe, but
not both
-
T2c: the tumour is in both
lobes
-
T3: the tumour has spread
through the prostatic
capsule (if it is only
part-way through, it is
still T2)
-
T3a: the tumour has spread
through the capsule on one
or both sides
-
T3b: the tumour has invaded
one or both seminal vesicles
-
T4: the tumour has invaded
other nearby structures
The designation "T2c" implies a
tumour in both lobes of the
prostate. Tumours which are
found to be bilateral on biopsy
only but which are not palpable
bilaterally should not be staged
as T2c.
-
Evaluation of the regional
lymph nodes ('N')
-
NX: cannot evaluate the
regional lymph nodes
-
N0: there has been no spread
to the regional lymph nodes
-
N1: there has been spread to
the regional lymph nodes
-
Evaluation of distant
metastasis ('M')
-
MX: cannot evaluate distant
metastasis
-
M0: there is no distant
metastasis
-
M1: there is distant
metastasis
-
M1a: the cancer has spread
to lymph nodes beyond the
regional ones
-
M1b: the cancer has spread
to bone
-
M1c: the cancer has spread
to other sites (regardless
of bone involvement)
Evaluation of the histologic
grade ('G')
Usually, the grade of the cancer
is evaluated separately from the
stage; however, for prostate
cancer, grade information is
used in conjunction with TNM
status to group cases into four
overall stages.
-
GX: cannot assess grade
-
G1: the tumour closely
resembles normal tissue
(Gleason 2–4)
-
G2: the tumour somewhat
resembles normal tissue
(Gleason 5–6)
-
G3–4: the tumour resembles
normal tissue barely or not
at all (Gleason 7–10)
The following is a more
contemporary consideration of
Gleason grade is:
-
Gleason 3+3: tumour is low
grade (favourable prognosis)
-
Gleason 3+4 / 3+5: tumour is
mostly low grade with some
high grade
-
Gleason 4+3 / 5+3: tumour is
mostly high grade with some
low grade
-
Gleason 4+4 / 4+5 / 5+4 /
5+5: tumour is all high
grade
Overall staging
The tumour, lymph node,
metastasis, and grade status can
be combined into four stages of
worsening severity.
Whitmore-Jewett staging
The Whitmore-Jewett system is
similar to the TNM system, with
approximately equivalent stages.
Roman numerals are sometimes
used instead of Latin letters
for the overall stages (for
example, Stage I for Stage A,
Stage II for Stage B, and so
on).
-
A: tumour is present, but
not detectable clinically;
found incidentally
-
A1: tissue resembles normal
cells; found in a few chips
from one lobe
-
A2: more extensive
involvement
-
B: the tumour can be felt on
physical examination but has
not spread outside the
prostatic capsule
-
BIN: the tumour can be felt,
it does not occupy a whole
lobe, and is surrounded by
normal tissue
-
B1: the tumour can be felt
and it does not occupy a
whole lobe
-
B2: the tumour can be felt
and it occupies a whole lobe
or both lobes
-
C: the tumour has extended
through the capsule
-
C1: the tumour has extended
through the capsule but does
not involve the seminal
vesicles
-
C2: the tumour involves the
seminal vesicles
-
D: the tumour has spread to
other organs
