Prostate cancer: What you need to know
As with cancers elsewhere in the body, some aggressive prostate cancers can grow and spread rapidly, while most grow slowly.
The stages 1 through 4 are only a part of the complex system doctors use to categorize cancer.
Doctors and people who have cancer refer to the disease in terms of stages 1, 2, 3, or 4. These stages are just part of a much more complicated system that is used to categorize cancer and how far it has spread.
When looking at prostate cancer, the standard is the American Joint Committee on Cancer (AJCC) TNM system. Here, those stages are defined as T1 to T4.
The T of TNM relates to the growth and location of the main tumor:
These tumors are found either during a procedure called a transurethral resection of the prostate (TURP), which is used to treat abnormal growth of the prostate, or during a needle biopsy. A needle biopsy is a test used to investigate a rise in prostate-specific antigen (PSA).
There are three different types of T1 tumor, categorized according to how the cancer is detected:
- T1a: detected during TURP, cancer is present in 5 percent, or less of the tissue removed
- T1b: detected during TURP, cancer is present in over 5 percent of the tissue removed
- T1c: discovered during needle biopsy
These tumors are larger than T1 tumors and are divided into three types according to their size and location:
- T2a: present in one half or less of one side of the prostate
- T2b: present in more than one half of one side of the prostate
- T2c: present in both sides of the prostate
These tumors have grown outside of the prostate.
These tumors have grown into the tissues outside of the prostate.
N shows if the cancer has spread to lymph nodes while M denotes whether or not it has spread, elsewhere in the body. This staging system also relies on two other important factors. These are the level of PSA in the blood at the time of diagnosis and the Gleason score.
PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. The Gleason score reflects how cancerous the cells appear and how likely that a tumor will spread.
Both factors are determined either through a biopsy or surgery.
Stage 1 prostate cancers are small and grow slowly. They are still within the prostate and are unlikely to be detected during an examination by a doctor.
Both Gleason scores and PSA levels are low. They may not result in symptoms or other health problems.
Unlike stage 1 prostate cancer, doctors can identify stage 2 prostate cancer during a physical exam.
Stage 2 cancers are also inside the prostate but can be felt by a doctor as they are larger than stage 1 cancers. They have higher Gleason scores or greater PSA levels, or both than stage 1 cancers.
There are two types of stage 2 prostate cancers, identified according to the size and location of the tumor: The two types are 2a and 2b.
Prostate cancers that are defined as 2a can be T1 tumors with high PSA or Gleason scores, or T2a or T2b with lower PSA or Gleason scores.
Prostate cancers that are identified as 2b will be T2c tumors, or T2a or T2b tumors with very high PSA or Gleason scores.
Stage 3 cancers have grown immediately outside the prostate. They may have reached the seminal vesicles but not the bladder or rectum. The seminal vesicles are glands that secrete a fluid that helps make up the semen.
Cancers that have developed to this stage are more likely to return after treatment.
Stage 4 cancers are the most serious as they have spread more widely to other areas. These are likely to include nearby organs, such as the bladder, rectum, or nearby lymph nodes. They may have even spread to distant organs, which can include bones.
While a few may be curable, most stage 4 cancers are not. With incurable cancers, the aims of treatment are to keep the cancer controlled for as long as possible and to improve the quality of life.
The treatment for prostate cancer will depend on how far the cancer has progressed.
As with any serious illness or disease, the ever-important decision about treatment needs to be made after much thought and discussion. Both the man and his doctor need to evaluate all options before making the final choice.
Men may also want to consider the opinions of their family and friends.
Depending on the type of prostate cancer, a man may decide not to have any treatment at first. If the prostate cancer is caught early, there are many things that a person needs to consider. These considerations include general health, age, and whether the cancer is likely to cause a problem.
Even when diagnosed at a later stage, there is still a lot to consider, such as possible side effects of the various treatments. Side effects can include erectile dysfunction and loss of bladder control, although these are both treatable.
Treatments can include:
- watchful waiting or active surveillance
- surgery, including removal of the prostate gland
- radiation therapy to kill cancer cells
- cryotherapy, a treatment that kills cancer cells with cold temperatures
- hormone therapy to reduce the effect that male hormones in the body have on cancer cells
- chemotherapy, involving the use of anticancer drugs
- vaccine treatment, which directs the immune system to attack cancer cells
The good news is that many men survive prostate cancer, especially if it is diagnosed in its early stages.
About 1 in every 7 men is diagnosed with prostate cancer, but most of them will survive. In fact, of every 39 men who develop prostate cancer, just one will die from the disease. There are more than 2.9 million men in the U.S. who are still alive after having been diagnosed with prostate cancer.
According to the American Cancer Society, of the men diagnosed with prostate cancer:
- the 5-year relative survival rate is almost 100 percent
- the 10-year relative survival rate is 98 percent
- the 15-year relative survival rate is 95 percent
Prostate cancer overview
Cancer involves cells growing out of control. These cancer cells can take hold almost anywhere in the body and can metastasize, or spread, to other areas or organs.
In prostate cancer, it is cells of the male-only prostate gland that grow out of control.
The prostate is a part of the reproductive system that is located just below the bladder. It plays a vital role at the time of ejaculation, secreting a milky fluid to flow into the urethra.
There are different types of prostate cancers but the most common are known as adenocarcinomas. These are derived from the cells that produce the prostate fluid before it is introduced into the semen.
Other types of prostate cancers include small cell carcinomas, transitional cell carcinomas, neuroendocrine tumors, and sarcomas, but these are all rare.