In order to start appropriate treatment for a patient diagnosed with prostate cancer, the stage of the cancer should be well known. For this reason, staging tests are applied after diagnosis. The stage of the cancer is the determination of whether the cancer is confined to the prostate or whether it has spread.
Tests used in prostate cancer staging:
PSA level: Prostate cancer tends to spread at high PSA levels. Especially at values of 20 and above, the risk of spread increases even more.
Biopsy result: Gleason Score is used in the pathological examination of the biopsy material. It shows how aggressive the cancer is. A value between 2 and 10 is given for both sides of the prostate section. The higher the value, the more aggressive and prone the cancer is to spread. While expressing the Gleason score, the result is written in binary numbers such as 3+4=7. In this example, most of the tumor is stage 3, a small portion is stage 4, with a gleason score of 7.
Ultrasound: With the ultrasound of the upper abdomen, information can be obtained whether the prostate cancer has spread to this region.
Chest X-ray : It gives an idea about whether prostate cancer has spread to the lung.
PET/CT: The whole body is scanned by giving a harmless protein, which is a special sugar. With the prostate, there is involvement in other lymph nodes, organs and tissues where cancer cells spread, if any. It gives detailed information about the spread of prostate cancer.
Bone scan: It is used to evaluate the bones that are most at risk of metastasis of prostate cancer.
Magnetic Resonance Imaging (MR): It gives an idea about prostate tissue and surrounding lymph nodes.
Prostate cancer stages:
TNM classification is used in the determination of prostate stages, as in other cancer types. The T value indicates the size of the tumor, the N value indicates the involvement of the surrounding lymph nodes, and the M value indicates whether there is spread to other organs and tissues. Stage is determined according to TNM values.
Stage 1: Prostate cancer is very small, not felt on rectal examination, limited to the prostate.
Stage 2: Cancer is limited to the prostate and can be felt on rectal examination.
Stage 3: The cancer has spread beyond the prostate and has spread to the surrounding lymph nodes and ejaculation tubes.
Stage 4: The cancer has spread beyond the prostate and has spread to surrounding tissues or distant organs (bladder, rectum, bones, lung, etc.).
Prostate cancer grades:
Grading is done to determine how fast prostate cancer can progress and the level of spread. Grading is determined using the patient’s PSA values and Gleason score.
Grade Group 1 = Gleason 6 (or less)
Grade Group 2 = Gleason 3+4=7
Grade Group 3 = Gleason 4+3=7
Grade Group 4 = Gleason 8
Rank Group 5 = Gleason 9-10
A risk level is determined according to these values in prostate cancer treatment planning.
Low-risk prostate cancer: Stage 1-2 and/or Gleason score less than 6, PSA less than 10.
Intermediate-risk prostate cancer: Stage 2 and/or Gleason score of 7, PSA between 10-20.
High-risk prostate cancer: T2-4 and or Gleason score 8-10, PSA greater than 20.