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Staging & Grading

article written by Dr. Hassan Khan

After your Urologist has diagnosed you with prostate cancer and explained to you your Gleason score he/she will next proceed to STAGE the cancer.

Staging the cancer helps the Urologist to determine the likely course of the cancer and if the cancer can be cured. It is an attempt to determine if the cancer is confined to the prostate gland or if it has spread (metastases).

A PSA value of 10ng/ml or less with a Gleason score of 7 or less suggests that the cancer is confined to the prostate. Your Urologist may choose further imaging studies to determine spread of the cancer.

Prostate cancer spreads directly to adjacent structures, the lymph nodes and commonly the bones of the spine.

Stages of Prostate Cancer

Stage 1

The tumor is very small; can't be felt on digital rectal examination (DRE)
Stage 2

Tumor growth in one (T2A) or both lobes (T2A) of the prostate; can be felt on examination
Stage 3

Tumor spreads locally outside the prostate capsule (T3A) or involves seminal vesicles (T3B)
Prostate Cancer Grading

Prostate cancer is not a uniform cancer but different patterns are present in each patient diagnosed. The GRADE of the cancer is determined by the pathologist looking under the microscope. There are several ways of grading prostate cancer of which the GLEASON system in most used.

The Gleason grade has the advantage in predicting the overall behaviour of the prostate cancer.

Cancers are called well differentiated when it looks and behaves very similar to the normal tissue.It is also called undifferentiated or poorly differentiated when it behaves very aggressive and has only little resemblance to the normal tissue.

The Five Gleason Grades

Gleason devised a simple system grading prostate cancer from 1 to 5 Grade 1 is well differentiated and grade 5 very poorly differentiated. Cancers are graded 2 to 4 according to the degree of differentiation.

Your pathology report will show two Gleason grades and these represent the two most common patterns seen in your biopsies. The Gleason score is simply the sum of these two grades. A score of 7 or less is considered curable if no evidence of spread of the cancer exists. (see prostate cancer staging)

Most prostate cancers behave typical to their Gleason score but unfortunately some low Gleason scores do badly and some high Gleason scores do well.. Therefore Gleason score in not the sole predictor of the bahaviour of prostate cancer.

The Gleason score, the PSA level and the clinical stage estimated by the Urologist combine to determine treatment options and the likely behaviour of prostate cancer.

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