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Stages of Prostate Cancer and Follow-up after Surgery


The September is Prostate Cancer Awareness Month to achieve the raise of acknowledgement on the danger of prostate cancer. On this page, we will be looking at the stages and grades of prostate cancer in terms of clinical point of view. We will also see, furthermore, why it is important to keep tracking the prostate cancer after treatments or surgeries.

A health care professional looking at the patient data (PSA)

Staging method

Prostate cancer cannot be exactly divided into the certain stages by looking at its appreance. The staging can be derived when certain criterias are met at the point of the disease. Before getting into the stages, we should check what types of prostate cancer staging standards are there:

  • Clinical Staging. In easy term to explain, this staging method is based on the usual examinations that you would received as you visit a hospital. The types of testings are prostate-specific antigen (PSA) testing, x-rays, bone scans, computed tomography (CT) scans, or magnetic resonance imaging (MRI). If your PSA value is higher than the PSA > 3 ng/mL, the health professionals may ask you for a digital rectal exame (DRE) based on Gleason score.

  • Pathologic Staging. The information of prostate cancer can be found by not only during the surgery but also the tissue analysis taken during the surgery. This is what we call, "pathology". Elimination of lymph nodes could also help provide more information on the stage of prostate cancer on the patient.

Staging systems

In order to provide the clinically effective diagnosis, there are several staging systems for prostate cancer.

TNM Staging System: The most widely used staging system for prostate cancer. The abbrevated T, N, M are representing the size of tumor, the involvement of lymph nodes, and the presence of distant metastateses. It is used to determine the stage of the cancer from stage 0 to stage IV.

  • T: T0 ~ T4. T0 indicates no evidence to tumor, and T4 means the tumor has grwon into nearby tissues such as the bladder or rectum

  • N: N0 to N3. N0 indicates no lymph node involvement, and N3 indicates the cancer has spread to nearby lymph nodes

  • M: M0 to M1. The presence or absence of distant mestastases in either M0 or M1

Combining the values of T, N, M concludes the stage of prostate cancer from earliest

stage (Stage I) to the most advanced stage (Stage IV).

Stage I. The early stage of slow growing cancer. The tumor cannot be felt. PSA level is low. The cell looks healthy.

Stage II.The tumor is only found in the prostate. PSA levels are medium or low. The size of cancer is small. There are sub categories of Stage II in A, B, C.

Stage III. PSA level is high. The cancer is in high grade. Mostly advanced cancer and grow fast and like to spread. Ther are sub categories of Stage III in A, B, C.

Stage IV. The cancer has spread beyond the prostate.

D'Amico Calssification: This staging system is based on the three facotrs, PSA level, biopsys Gleason score, and clinical stage.

  • The low-risk group: PSA level less or equal to 10 ng/mL, a biopsy Gleason score of 6 or less, and a clinical stage T1-T2a (prostate cancer is confined in the prostate)

  • The intermediate group: PSA level (10 ~ 20 ng/mL). Gleason score of 7, or a clinical stage T2b-T2C. (The prostate cancer spreads beyond the prostate but not trasmitted to the near lymph nodes)

  • THe high-risk group: PSA level greater than 20 ng/mL, a biopsy Gleason score of 8 ~ 10. A clinical stage T3 - T4. (The cancer spreads to near tissues or organs)

Partin Tables: The table is named after Alan W. Partin, MD, PhD, who developed the system in early 1990s. Other than classification system, it does not have certain stages but provide a predictive model which estimates the probability of extraprostatic extension (EPE) based on several factors, such as PSA level, biopsy Gleason score, and clinical stage. It provides the percentage estimate range from a low (less than 10%) to a high probability (greater than 50%).

Epstein Criteria: The Epstein criteria is a prostate cancer staging system which categorizes of prostate cancer into three risk groups. The criteria is based on the factors, PSA level, biopsy Gleason score, and number of psoitive biopsy scores.

  • Very low risk: PSA level less than or equal to 2 ng/mL, biopsy Gleason score of 6 or less, and only one positive biopsy score with less than 50% of cancer involvement

  • Low risk: PSA level less than 10 ng/mL, biopsy Gleason score of 6 or less, and no more than two positive biopsy cores with no more than 50% of cancer involvement

  • Intermediate risk: PSA level between 10 - 20 ng/mL, biopsy Gleason score of 7, or more than three positive biopsy cores with no more than 50% of cancer involvement

This criteria is often used for identifying a men who is in active surveillance for guiding him for treatment decisions.

Once the staging of prostate cancer is carried out by the health professionals, the recurrence of prostate cancer should be followed up in order to prevent further severity of prostate cancer. What are the recurrence monitoring follow-up for prostate cancer?

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Follow up

In general, you may have side effects or long-term effects after prostatectomy. The following common side effects can be found:

  • Urinary incontinence: the loss of bladder control. You may experience leakage of urine and difficulty controlling your urge to urinate.

  • Erectile dysfunction: the inability to get or maintain an erection. This can occur immediately after surgery or may develop over time.

  • Bowel problems: changes in bowel movements or discomfort during bowel movements.

It is important to discuss these potential side effects with your healthcare provider and develop a plan to manage them. Additionally, regular follow-up appointments with your healthcare provider are essential to monitor for recurrence of prostate cancer.

Other than the general side effects, the patient and the health professionals need to check on the recurrence of prostate cancer by checking PSA levels. According to AUA guideline (The American Urological Association), biochemical recurrence is defined as follows:

  • PSA level higher than 0.2 ng/mL (more than two occasions) after radical prostatectomy

  • PSA level higher than 0.2 ng/mL (a single occasion) after radical prosatectomy, followed by a rise in PSA level more than two occasions

The biochemical recurrence PSA level testing can be affected by inflammation or infection in the prostate gland. Therefore, the complicated recurrence monitoring should be done to confirm it. Nevertheless, PSA level testing is the easier method for monitoring the status of prostate.

It is alway important to consult with a healthcare provider for individualized recommendations regarding the monitoring and management of the cancer.

This content is intended for educational purposes only and is not a substitute for professional medical advice. If you have any questions or concerns about your health, please consult with a healthcare professional.


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