Prostate Cancer Stages Cancer is a disease process that usually begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. It forms a clone and proliferates at an abnormal rate. The cells acquire invasive characteristics and infiltrates tissues surrounding it. Cancerous cells are described as malignant neoplasms that demonstrate uncontrolled cell growths and follow no physiologic demands. Prostate cancer is a kind of cancer that develops in the prostate. The prostate is the gland seen below a man's bladder that produces fluid for semen. The cancer may spread to other parts of the body like the bones and lymph nodes. It may cause pain, difficulty in urinating, erectile dysfunction and discomfort during sexual intercourse. Prostate cancer tends to develop in men older that 50 years old. Its specific cause is unknown. Prostate cancer is the 2nd leading cause of death in the United States in 2004 (From the American Cancer Society, 2004). Cancer Staging and Grading A systematic approach to diagnosis and treatment of prostate cancer starts with a complete diagnostic evaluation that includes identifying the grade and stage of the tumor. This is done before treatment begins to provide baseline data for evaluating treatment outcomes. Staging determines the existence of metastasis as well as the size of the tumor. The TNM system is often used (Green, et.al., 2002). In this system, “T” refers to the size of the primary tumor, “N” refers to the lymph node involvement, and “M” refers to the extent of the metastasis.
Grading defines the type of tissues from which the tumor originated. The tumor is assigned a numeric value from I to IV. Grade I tumors – also called as the well-differentiated tumors, closely resemble the tissue of origin in structure and function. Tumors that do not clearly resemble the original tissue in structure and function are described as poorly differentiated and are assigned a grade IV. These tumors are less responsive to treatment and tend to be more aggressive. TNM Classification System T
The extent of the primary tumor
N
The absence or presence and extent of regional lymph node metastasis
M
The absence or presence of distant metastasis
Primary tumor (T) Tx
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ
T1, T2, T3, T4 increasing size and/or local extent of the primary tumor
Regional Lymph Nodes (N) Nx
Regional lymph nodes cannot be assessed
N0
No regional lymph node metastasis
N1, N2, N3
Increasing involvement of regional lymph node
Distant Metastasis Mx
Distant metastasis cannot be assessed
M0
No distant metastasis
M1
Distance metastasis
Signs and Symptoms Early stage of prostate cancer causes no symptoms. If it does, its symptoms resemble that of benign prostatic hyperplasia. It includes frequent urination, most especially at night, difficulty starting and maintaining a steady stream of urine, blood in urine and painful urination. Biopsy is the only test that can fully confirm the diagnosis of prostate cancer.