Staging Of Prostate Cancer

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[edit] Staging Of Prostate Cancer

As in other cancers it is important to assess at which level the cancer is at the time of diagnosis. This is called staging. It might involve some X rays, perhaps a bone scan and more blood tests such as a acid phosphatase, which correlates well with the presence of metastases in lymph nodes. A transrectal ultrasound (TRUS) and a TRUS guided prostate biopsy in 6 different areas of the prostate would also be required.

Finally the doctor may want to employ a CT or MRI scan to delineate any involvement outside the prostatic capsule.

The following stages have conventionally been used:

Staging of Prostate Cancer
Stage	Prostate cancer involvement
A	positive PSA and confirmed by biopsy, confined to one lobe, is clinically not visible by imaging techniques or exam
B	Is clinically palpable by rectal exam; visible on TRUS, subclasses confined to one or both lobes
C	Extends through prostatic capsule with local regional metastases,sometimes with seminal vesicle invasion
D	prostate is fixed due to extensive invasion of adjacent structures including pelvic bone, may also have distant metastases

The significance of this staging procedure becomes evident when the prostate cancer survival rates are reviewed (see below):

Prostate cancer survival
Stage	5-year survival	10-year survival
A	100%	97%
B	89%	71%
C	80%	66%
D	29%	0%

It is very clear from these statistics and the knowledge of the biology of prostate cancer that there is not such thing as a "clinically unimportant" prostate cancer. If the early cancer is missed (stage A or B), it progresses relentlessly into stage C or D and kills the patient.

This table also tells that as long as the patient has a localized prostate cancer (stage A), there is hope for longterm survival. For the first time in milleniums with the help of the PSA test in combination with a rectal examination we have the tools of changing history. With prostate cancer we are at a similar point in time where we were with cervical cancer cure rates in women in the 1960's and 1970's. Every eductated woman in the world knows that a yearly Pap test and pelvic examination can prevent cancer of the cervix and ovarian cancer. Every man from now on will accept that he has a responsibility to prevent prostate cancer.

With prostate cancer early diagnosis, like with any other cancer, is the key to successful cures!

This reinforces the fact that an annual PSA test and rectal prostate examination needs to be done in every man beyond the age of 45 to 50 to detect and treat prostate cancer early.

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References:

The following references were used apart from my own clinical experience:

1. Cancer: Principles &Practice of Oncology, 4^th edition, by V.T. De Vita,Jr., et. al J.B. Lippincott Co.,Philadelphia, 1993. Vol.1: Chapter on Prostate cancer.

2. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.Chapter 233, p.1918-1919.

3. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T.DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on prostate cancer.

4. A Waghray et al. Cancer Res 2001 May 15;61(10):4283-4286.

5. BM Fisch et al. Urology 2001 May;57(5):955-959.

6. CC Parker et al. BJU Int 2001 May;87(7):629-637.

7. B Aschhoff Drugs Exp Clin Res 2000;26(5-6):249-252.

8. Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

9. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc