prostate cancerIn 2020, almost 200,000 people were affected. Fortunately, the prognosis for prostate cancer is usually positive as it usually grows and spreads slowly.
Only a small proportion of cases end in death. In fact, the 5-year relative survival rate for prostate cancer is 97.8%.
Prostate cancer, like most other solid cancers, develops in stages. However, additional risk assessment tools are also used to guide treatment, including whether surgery is needed.
This article explains what tools are used to diagnose cancer and assess risk, and how they are used to make treatment decisions.
Stage of prostate cancer
medical devicecancer in the stadiumto determine how much cancer is in the body and whether it has spread.This can help a person with cancer determine the best treatment and assess their chances of survival.
The TNM system, developed by the American Joint Committee on Cancer (AJCC), is the most widely used cancer staging system. The acronym describes several cancer factors, including:
- T (guz): Size and extent of the main tumor
- N (tal): the number of nearby lymph nodes with cancer
- M (metastases): Whether the tumor has spread to other parts of the body
Once the diagnosis is confirmed, several tests and procedures are used to detect prostate cancer.
PSA blood test
INPSA blood testlooks for elevated levels of prostate-specific antigens (PSA) in the blood. When the test is used in people who have already been diagnosed with prostate cancer, it can help determine the stage of their cancer.
By combining elevated PSA levels with a physical exam and biopsy results, a healthcare professional can determine how much prostate cancer is present in the body and whether it has spread to other parts of the body.
Healthcare professionals perform aProstate cancer biopsyby removing part of the prostate to check for abnormal cells and activity. The most common type of biopsy is the punch biopsy.
In this procedure, the doctor inserts a long, thin, hollow needle through the anus or the skin between the anus and the scrotum to collect up to 12 samples. The tumor grade is then assigned based on the results. The grade depends on how abnormal the tumor looks under the microscope.
TheSystem GleasonaIt assigns tumor grades based on how closely the cancer resembles normal prostate tissue. The grades go from 1 to 5 (most normal to least normal). Almost all cases of prostate cancer are grade 3 or higher.
Because prostate cancer often has areas of varying severity, the stage is assigned to the two areas that make up the bulk of the cancer. These two grades are then added together to give a Gleason score, which can range from 2 to 10.
Based on the result, prostate cancer is divided into three groups:
- Well differentiated or worse (score 6 or less)
- Middle class or middle class (7th grade)
- Poorly differentiated or high quality (score 8 to 10)
However, the Gleason score is not always the best way to describe the stage of cancer. This is because prostate cancer scores fall into more than three groups, and the Gleason score scale can be confusing.
Experts have developed groups of notes to fill these gaps. They range from 1 (most likely to grow and spread slowly) to 5 (most likely to grow and spread quickly). The groups of nodes correspond to different Gleason scores:
- Assessment group 1:Gleason score of 6 or less
- Assessment group 2:Gleason's score of 3+4=7
- Class group 3:Gleason's score of 4+3=7
- Class group 4:Gleason score of 8
- Class group 5:Gleason scored 9 and 10
|Stages of prostate cancer|
|AJCC practice||phase grouping||scene description|
|I||cT1, N0, M0 Grade 1 group PSA less than 10LUBcT2a, N0, M0 Grade 1 group Gleason score 6 or less PSA less than 10LUBGrade pT2, N0, M0 Group 1 Gleason score 6 or less PSA less than 10||Doctors cannot feel the tumor or see it with an imaging technique such as transrectal ultrasound (it was discovered during transurethral resection of the prostate or diagnosed by needle biopsy for high PSA). The cancer has not spread to nearby lymph nodes or other parts of the body.LUBThe tumor can be felt by palpation through the rectum or seen with imaging tests such as transrectal ultrasound and is located on one half or less of the side (left or right) of the prostate. The cancer has not spread to nearby lymph nodes or other parts of the body.LUBThe prostate was surgically removed and the tumor was still only in the prostate. The cancer has not spread to nearby lymph nodes or other parts of the body.|
|IIA||cT1, N0, M0 Grade 1 group PSA at least 10 but less than 20LUBcT2a or pT2, N0, M0 Grade 1 group PSA at least 10 but less than 20LUBcT2b or cT2c, N0, M0 Grade 1 group PSA at least 10 but less than 20||Doctors cannot palpate the tumor or see it with imaging techniques such as transrectal ultrasound (it was discovered during transurethral resection of the prostate or diagnosed by needle biopsy for high PSA). The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].LUBThe tumor can be felt by palpation through the rectum or seen with imaging tests such as transrectal ultrasound and is located on one half or less of the side (left or right) of the prostate. Or the prostate was surgically removed and the tumor was still only in the prostate. The cancer has not spread to nearby lymph nodes or other parts of the body.LUBThe tumor can be palpated with a digital rectal examination or seen with imaging tests such as transrectal ultrasound. It is located on more than half of one side of the prostate or on both sides of the prostate. The cancer has not spread to nearby lymph nodes or other parts of the body.|
|IIB||T1 or T2, N0, M0 Grade 2 group PSA less than 20||The cancer has not yet spread beyond the prostate. It may or may not be palpable on digital rectal examination or imaging tests such as transrectal ultrasound. The cancer has not spread to nearby lymph nodes or other parts of the body.|
|IIC||T1 or T2, N0, M0 Class 3 or 4 PPE under 20 years||The cancer has not yet spread beyond the prostate. It may or may not be palpable on digital rectal examination or imaging tests such as transrectal ultrasound. The cancer has not spread to nearby lymph nodes or other parts of the body.|
|IIIA||T1 or T2, N0, M0 Class 1 to 4 PPE at least 20||The cancer has not yet spread beyond the prostate. It may or may not be palpable on digital rectal examination or imaging tests such as transrectal ultrasound. The cancer has not spread to nearby lymph nodes or other parts of the body.|
|IIIB||T3 or T4, N0, M0 Class Group 1 to 4 Any PSA||The cancer has grown outside the prostate and may have spread to the seminal vesicles or other tissues adjacent to the prostate, such as the urethral sphincter, rectum, bladder and pelvic wall. It has not spread to nearby lymph nodes or elsewhere in the body.|
|IIIC||Any class group T, N0, M0 5 Any PSA||Cancer can grow outside the prostate and into surrounding tissue. It has not spread to nearby lymph nodes or elsewhere in the body.|
|IVA||Any T, N1, M0 Any group of notes Any PSA||The tumor may or may not grow into tissue near the prostate. The cancer has spread to nearby lymph nodes, but has not spread to other parts of the body. The rating group can be any value and the PSA can be any value.|
|IVB||Any T, any N, M1. Any group of notes. All personal protective equipment||Cancer can grow in the tissues near the prostate and may have spread to nearby lymph nodes. It has spread to other parts of the body, such as distant lymph nodes, bones or other organs.|
Health professionals divide prostate cancer into stages. Staging helps determine how much cancer is in the prostate and whether it has spread. Doctors rely on a PSA blood test, biopsy and Gleason score to determine the stage of prostate cancer.
For people who have recently been diagnosed with prostate cancer, healthcare professionals will assess each case individually to determine how aggressive the tumor may be and determine the appropriate course of actionTreatment.
The National Comprehensive Cancer Network (NCCN) has developed guidelines for categorizing prostate cancer into risk groups. They take into account blood tests and test results, genetic test results and family history to determine the appropriate risk group:
- Very low: Includes T1c, grade 1 group, which has a PSA of less than 10 ng/mL, where the PSA density is less than 0.15 ng/mL, and cancer is present in one or two biopsies with a concentration of less than than 10 ng/mL, more than half of all samples were found to show signs of cancer
- Map: Includes T1 to T2a, stage 1 and PSA less than 10 ng/ml
- Moderately cheap: Includes patients with an intermediate risk factor who are stage 1 or 2 and less than half of the biopsies showed cancer
- Moderately unfavorable: Includes stage 3 individuals with more than half of their biopsies positive for cancer and who had two or more intermediate risk factors
- Hoch: Includes those with T3a or grade 4 or 5 or those with a PSA greater than 20 ng/ml
- Very high: Includes people with stage T3b or T4 or primary Gleason 5 pattern, or people with more than four biopsies showing cancer or two or three high-risk features
Prostate cancer survival rates and statistics
Risk assessment tools
In addition to NCCN guidelines, healthcare providers also use a variety of risk assessment tools to support clinical decision making.
TheD'Amico classificationwas developed in 1998. It uses the following elements to estimate the risk of prostate cancer recurrence:
- PSA value
- Gleason score
Because multiple risk factors are not taken into account, accuracy may be lower for people with more than one risk factor.
Five prostate cancer nomograms can be used to assess risk and predict treatment outcomes. They are based on the specific characteristics of a person's disease:
- FuriousprostatectomyNomogramit is used to predict the long-term outcome and extent of cancer after removal of the prostate and surrounding lymph nodes in people who have not yet started treatment.
- Nomogram after radical prostatectomyIt is usedafter surgical interventionprediction of cancer recurrence 2, 5, 7 and 10 years after surgery. It is also used to determine the probability of survival within 15 years after surgery.
- recoveryradiation treatmentNomogramit is used to predict how effective salvage radiation therapy will be after radical prostatectomy if the cancer recurs. It is also used to determine the likelihood of cancer control and levels of undetectable PSA for 6 years after salvage therapy.
- risk of deathprostate cancer in people with elevated PSA levels after radical prostatectomy.This makes it possible to estimate the risk of death in case of recurrence of prostate cancer after radical prostatectomy, which is signaled by an increase in the PSA level. It predicts the likelihood that a man who initially had surgery will die from prostate cancer 5, 10 and 15 years after the PSA begins to rise.
- Risk of high-grade cancer in the prostate biopsy nomogramit is used to estimate the likelihood of high-grade prostate cancer in people who have been determined by a urologist to be eligible for a prostate biopsy. This tool does not apply to people who have already been diagnosed with prostate cancer.
The Prostate Cancer Risk Assessment (UCSF-CAPRA) estimates the risk of prostate cancer based on:
- age at diagnosis
- PSA at diagnosis
- Gleason-Score der Biopsi
- clinical stage
- Percentage of biopsy samples showing cancer
Each factor is assigned a score and then summed to calculate the final risk score. Therefore, lower values mean less risk and vice versa.
Prostate screening is a personal decision that everyone must make for themselves. However, the American Urological Association (AUA) offers the following guidelines:
- Recommended for routine check-ups for people under 40 years of age
- Routine screening is not recommended for people ages 40 to 54 who are at average risk
- Shared decision-making between a person and their health care provider aged 55 to 69
- Routine screening is not recommended for people over 70 or people with a life expectancy of less than 10-15 years
Genomic and proteomic tests
Genomic and proteomic testing can be used to better understand the potential for cancer to grow or spread. To determine the risk, they study both genes and proteins that are active in prostate cancer cells. Tests used include Oncotype DX, Prolaris, ProMark and Decipher.
Risk assessment tools can help healthcare professionals determine how cancer may behave after treatment based on factors such as age at diagnosis and staging and screening results.
Prognostic tools before diagnosis
In addition to the risk assessment tools used to guide cancer treatment, there are also tools to predict the likelihood that a biopsy will detect prostate cancer. These tools help prevent diagnostic errors and unnecessary biopsy procedures.
Risk Calculator for Prostata Cancer Prevention Study (PCPT).
The Prostate Cancer Prevention Risk Calculator is designed to help doctors decide if a biopsy is needed. It takes into account many clinical factors, including:
- PSA value
- exam results
- family history
- biopsy history
Calculator results may not apply to everyone. Doctors should only use it for those who:
- are 55 or older
- You have not previously been diagnosed with prostate cancer
- Have PSA or DRE results older than 1 year
Risikorechner der Prostate Biopsi Collaborative Group (PBCG).
The Prostate Biopsy Collaborative Group (PBCG) Risk Calculator is similar to the PCPT in that it considers various factors to determine biopsy eligibility. In this way, it can help reduce unnecessary biopsies. However, this and the PCPT calculators showed differences in results between racial groups.
With this in mind, treatment for prostate cancer is imminent, as the 5-year relative survival rate for all stages combined is as high as 98%. Therefore, experts believe that some treatment options are unnecessary for survival.
make treatment decisions
Prostate cancer is easy to control, especially in the early stages. However, before undergoing any treatment, you may want to discuss options with your doctor to avoid unnecessary procedures.
If you are a server, active monitoring or watchful waiting for treatment may be a good option. It is also important to consider the type of treatment and how well you will cope with it. For those who are unwilling or unable to undergo surgery, radiation therapy may be a good option.
Side effects of the treatment should also be considered, especially if you are in a low-risk group. There may be some side effects such as urinary incontinence, impotence and bowel problems.Knowing how much time you are willing to spend in treatment or recovery can also help you and your doctor decide which treatment is best for you.
How prostate cancer treatment affects life expectancy
Prostate cancer has an extremely high survival rate. For this reason, health professionals are very careful about screening, diagnosis and treatment.
Pre-diagnosis prediction tools can help your doctor decide if you are a good candidate for screening. Once cancer is diagnosed, several tests are used to categorize the cancer and predict cancer risk. All of this helps narrow down the treatment options that are best for you.
A word from Verywell
Deciding which treatment is best for you can be difficult. If you are not satisfied with the options offered, you can always get a second opinion. Many professionals prefer one form of treatment over another. For example surgeryOncologistmay insist on surgery, while the radiologist oncologist is likely to suggest itradiation.
As it can be confusing to decide what is best for you, contacting and discussing it with your GP can help you find out all the options available to you. They know you well and can help you decide what is best for you.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts in our articles. Read oureditorial processto learn more about how we fact-check and ensure our content is accurate, reliable and trustworthy.
Barsouk A, Padala SA, Vakiti A i in.Epidemiology, staging and treatment of prostate cancer.Medical Sciences (Basel). 2020;8(3):28. doi:10.3390/medsci8030028
National Cancer Institute.Cancer stage.
American Cancer Society.Tests for diagnosing and staging prostate cancer.
National Cancer Comprehensive Network Foundation.NCCN Patient Guidelines: Early Prostate Cancer.
Centrum Onkologii Memorial Sloan Kettering.Prostate cancer nomogram.
University of California San Francisco.Prostate cancer risk assessment and the UCSF-CAPRA score.
American Urological Association.Early detection of prostate cancer (2018).
American Cancer Society.Prostate cancer staging and other risk assessments.
Ankerst DP, Hoefler J, Bock Si in.Prostate Cancer Prevention Study 2.0 Risk Calculator for predicting low- and high-grade prostate cancer.urologer. 2014;83(6):1362-1368. doi:10.1016/j.urology.2014.02.035
Carbonaru S., Nettey OS, Gogana P. and in.Comparative analysis of the effectiveness of the PBCG and PCPT risk calculators in a multiethnic cohort.BMC Urol. 2019;19(1):121. doi:10.1186/s12894-019-0553-6
American Cancer Society.Survival rates for prostate cancer.
American Cancer Society.Prostate cancer treatment considerations.
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She is trained in both psychology and journalism, and her dual education has given her the research and writing skills she needs to deliver informed and engaging content in the healthcare space.
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Hormone therapy is often used to treat advanced prostate cancer to shrink the cancer and slow its growth. Hormone therapy is sometimes used before radiation therapy to treat cancer that hasn't spread beyond the prostate. It helps shrink the cancer and increases the effectiveness of radiation therapy.What is the number one treatment for prostate cancer? ›
Active surveillance, surgery, and radiation therapy are the standard therapy choices for men with early-stage prostate cancer (see Types of Treatment, starting on page 8). Each has benefits (how treatments can help) and risks (problems treatment may cause). There is seldom just one right treatment choice.What is the best medication to shrink an enlarged prostate? ›
Alpha-blockers, such as tamsulosin (Flomax) or terazosin (Hytrin), which relax muscle tissue. 5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), which shrink the prostate. A combination of the two, which, when used long-term, may help your symptoms more than either medicine alone.What is the latest treatment for enlarged prostate 2023? ›
The latest treatments for an enlarged prostate may help reduce prostate size or reduce symptoms. Treatments include water vapor thermal therapy, prostatic urethral lift, and prostate artery embolization.What is the safest treatment for enlarged prostate? ›
A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy has a lower risk of side effects than does nonlaser surgery. It might be used in people who shouldn't have other prostate procedures because they take blood-thinning medicines.Is it better to have prostate surgery or radiation? ›
Both treatments work well. With either treatment, the chance of your cancer spreading is low. Both treatments have side effects, such as bladder, bowel, and erection problems. Radiation therapy is more likely to cause bowel problems.What is the newest and best treatment for prostate cancer? ›
Targeted radiation therapy and PSMA
This new compound can potentially find, bind to, and kill prostate cancer cells throughout the body. In a recent clinical trial, men with a type of advanced prostate cancer who received a PSMA-targeting drug lived longer than those who received standard therapies.
The most common chemotherapy drug for prostate cancer is docetaxel (Taxotere), which is usually given with prednisone, a steroid medicine. After starting docetaxel, many men experience the improvements in disease-related symptoms, including pain, fatigue and loss of energy.How do I get my enlarged prostate back to normal? ›
Medication is often the first step of enlarged prostate treatment. There are multiple drugs that can help reduce BPH symptoms, including: 5-alpha reductase inhibitors that help shrink the prostate. Alpha blockers that relax prostate muscle fibers and bladder neck muscles.Does Flomax shrink the prostate? ›
Tamsulosin helps relax the muscles in the prostate and the opening of the bladder. This may help increase the flow of urine or decrease the symptoms. However, tamsulosin will not shrink the prostate. The prostate may continue to get larger.
TURP, the original gold standard
TURP, which involves inserting a scope into the urethra and cutting out prostate tissue with an electrified wire loop, is an alternative to more invasive robotic or open BPH surgeries.
The newly approved treatment combines enzalutamide with a second drug, talazoparib, that was already on the market for female cancer patients who test positive for BRCA mutations. These inherited gene defects boost risks for breast and ovarian cancer, but they can also elevate risks for prostate cancer in men.What will a urologist do for enlarged prostate? ›
With this surgery, a urologist uses a high-energy laser to destroy prostate tissue. The urologist uses a cystoscope to pass a laser fiber through the urethra into the prostate. The laser destroys the enlarged tissue.
A prostatic urethral lift (also known as a UroLift) is recommended as an alternative to having a TURP or HoLEP. A surgeon inserts implants that hold the enlarged prostate away from the urethra so that the urethra is not blocked. This helps to relieve symptoms like pain or difficulty when peeing.When should I have my prostate removed? ›
Generally speaking, prostatectomy is reserved for patients with aggressive disease who are otherwise healthy and have a remaining life expectancy of ten years or more.