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Prostate Cancer Stages

Prostate Cancer Clinical Staging

The exact cause of prostate cancer remains unknown. The only well-established risk factors are age, ethnicity, and heredity. The clinical stage is based on the urologist's clinical examination of the patient's prostate (via palpation or DRE) and this is combined with other results of tests done prior to definitive treatment (i.e. surgery or radiation). The DRE involves digital palpation of the gland for size and any abnormalities. Based on these results, the urologist may suggest performance of a systematic biopsy of the gland to determine a diagnosis. Additionally, the urologist may suggest possibly X-rays, CT scans, and bone scan, but these tests may not always be needed. They are usually recommended based high levels of serum PSA as well as the biopsy Gleason score and/or volume (size) of the cancer.

The clinical stage of the prostate cancer is described below:

T1: The tumor cannot be felt during the DRE and is not seen during imaging (any test that produces pictures of the inside of the body, such as a CT scan). It may be found when surgery is done for another reason, usually for BPH, or abnormal growth of benign prostate cells.

T1c: The tumor is found during a needle biopsy, usually because the patient has an elevated PSA level.

T2: The tumor is found only within the prostate, not other areas of the body. It is large enough to be felt during the DRE.

T2a: The tumor has invaded one-half of one lobe (part or side) of the prostate and may be palpated during the DRE.

T2b: The tumor has spread to more than one-half of one lobe of the prostate, but not to both lobes and may be palpated during the DRE.

T2c: The tumor has invaded both lobes of the prostate and may be palpated during the DRE.

More Information About Prostate Cancer Staging from Johns Hopkins Medicine

Urologist speaking with patient

Partin Tables

For decades, doctors around the world have used the Partin tables to guide treatment decisions. Developed by Johns Hopkins urologists Alan Partin and Patrick Walsh, the tables use features of each man’s cancer to predict whether a tumor will be confined to the prostate — making it easier to select the most appropriate therapies.

Use the Partin tables.

Pathological Staging

Following surgery to remove the prostate gland, a pathologist will assign the Gleason score and stage (extent of the size and spread of the cancer). They utilize the standardized T, N, and M classification to define TNM combinations to describe each stage of prostate cancer. The TNM is an abbreviation for tumor (T), lymph node (N), and metastasis (M) to lymph nodes and/or bone or other organs. Urologists look at these three parameters to determine the stage (extent) of cancer:

Prostate Cancer Pathologic Stage Grouping Chart (Current system)


Stage

T

N

M

I

T1a, T1b, or T1c

N0

M0

 

T2a

N0

M0

 

Any T1 or T2a

N0

M0

IIA

T1a, T1b, or T1c

N0

M0

 

T1a, T1b, or T1c

N0

M0

 

T2a

N0

M0

 

T2b

N0

M0

 

T2b

N0

M0

IIB

T2c

N0

M0

 

Any T1 or T2

N0

M0

 

Any T1 or T2

N0

M0

III

T3a or T3b

N0

M0

IV

T4

N0

M0

 

Any T (lymph nodes +)

N1

M0

 

Any T

Any N

M1

 

Use the Partin Tables to predict Your Pathological Stage

The new Partin Nomogram Defines Pathological Stages (Extent of Disease) as:

Organ Confined Prostate Cancer (OC) – Within the prostate gland

Extracapsular Extension (ECE) – Tumor has broken through the capsule of the prostate gland. This is not inoperable prostate cancer necessarily. Also it can be referred to as extraprostatic Extension (EPE).

Seminal Vesicle (SV) - The tumor has spread to the seminal vesicles adjacent to the prostate (see image).

Lymph Nodes (LN) - The tumor has spread to the lymph nodes near the prostate gland.

Knowing the stage of prostate cancer can help to determine how aggressively it needs to be treated and how likely it is to be removed by the available treatment options.

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