Staging

Christopher Lukas Health Guide
  • It’s fairly easy to forget that all cancers are not the same, and that all prostate cancers are not the same, either.
    At the following URL, you can get some very good information (including graphics) from the National Cancer Institute regarding the staging of prostate cancer.

    www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2

    Just what is staging?

    It’s the determination of how far your particular prostate cancer has grown. Is it a small tumor wholly within the prostate gland? Does it occupy all quadrants of the prostate? Has it begun to migrate (metastasize) outside the gland? Has it entered bones or other organs?
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    Determining the staging is not the same as a Gleason score. The Gleason (a score based on your original biopsy) tells the oncologist how different the cells in your prostate are from normal cells, and, based on that, how fast your cancer is likely to grow and spread.

    Staging, on the other hand, is how far the cancer has already spread, and how large a tumor you have. (The word, “tumor” is actually more frightening to some people than the word “cancer,” but they mean the same thing. A tumor is a clump of cells that are not normal. They may be cancerous or benign (not cancerous.)

    Until staging has been accomplished, oncologists can’t advise you how you should be treated.
    The NCI site is very good on this subject.

    A few words, however, on percentages. This is where numbers become important. It’s helpful to a lot of people to know what percentage of prostate tumors that are discovered end up being in Stage I or II (within the prostate entirely), Stage III (outside the gland as well) or Stage IV (metastasized into bones and/or other organs). For, this is the scary stuff: if your cancer is not only one of the fast-moving kind and is already out of the gland, it can mean a lot of treatment, a lot of worry, perhaps some pain, and not a great deal of hope – at least as present treatments go.

    So, here goes:

    In the latest (1995) prostate cancer census approximately 84% of prostate cancers were found to be localized.

    Approximately 20% were regional, i.e., outside the prostate gland.

    Approximately 4% were “distant,” i.e. in other organs or the bones.

    The percents don’t quite add up, due to rounding off of figures.

    The likelihood of having a cancer that is advanced and distant is, as you can see, quite low, especially since this figure does not refer to all men, but only those who are diagnosed with prostate cancer, at the present about 18% of all men.

    Keep in mind, however, that there are differences between races here – with Black men tending to have a greater likelihood of prostate cancer, and of a more advanced stage than white men. Each year, a new statistic is found, so what happened in 1995 may be quite different from what happened in 2005. Finally, the grade (i.e., the differentiation determined by your Gleason score) will be different for each person, and may help you make up your mind as to whether you want treatment or not; and what kind of treatment you want.

  • I have barely touched the surface of the staging and grading issue. It is complex. It is much easier to throw all the decision-making to your oncologist and forget about the details.
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    My own, personal belief, is that that is a mistake. Prostate cancer is one of those rare cancers that generally moves slowly and, again, in general, will most likely not kill you, if you’re already over 65 or 70 and if it’s a moderately differentiated grade and Stage I or II. But that’s scarce comfort to many men. It’s cancer and that’s a frightening word.
Published On: August 22, 2006