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Diagnosing Prostate cancer
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
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.
Stage Tumour Nodes Metastasis Grade
Stage I T1a N0 M0 G1
Stage II T1a N0 M0 G2–4
T1b N0 M0 Any G
T1c N0 M0 Any G
T1 N0 M0 Any G
T2 N0 M0 Any G
Stage III T3 N0 M0 Any G
Stage IV T4 N0 M0 Any G
Any T N1 M0 Any G
Any T Any N M1 Any G
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.
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