Prostate cancer stage, starting from the beginning to the final stage

When you are diagnosed with prostate cancer, your doctor will generally find out the stage of your cancer. The stage or stage of cancer describes how much cancer is in the body and how it spreads. This helps your doctor determine which prostate cancer treatment is right for you. Then, how do you explain the stages of prostate cancer, from stage 1 to stage 4?

The steps to determine the stage of prostate cancer

Stage in prostate cancer is the stage that determines how the development of cancer cells in the prostate gland and whether the cancer cells have spread to other parts of the body. Based on the latest American Joint Committee on Cancer (AJCC) in 2018, there are three main keys in determining the stage of prostate cancer, namely:

1. The TNM system

The TNM system is generally described in the following way:

T (tumor), which shows how large the tumor is and where the tumor is located.
N (Node/ lymph nodes), which indicates whether the tumor has spread to the lymph nodes and how widely it has spread.
M (Metastasis), which shows whether cancer cells have spread beyond the prostate gland or to other parts of the body and how much they have spread.

Each letter above will be accompanied by a number. This number will assess how much cancer cells have developed in your body. The bigger the number, the more severe your prostate cancer is.

2. PSA level

Protein-specific antigen (PSA) is a protein made by cells in the prostate gland, both normal cells and cancer cells. PSA is mostly in semen, but this protein is also in the blood.

PSA is generally seen at the time of testing or screening for prostate cancer, especially the PSA test. The higher the PSA level you have, the greater the chances of suffering from prostate cancer.

3. Gleason score

The stage of prostate cancer is also determined by looking at the Gleason score when the doctor makes a diagnosis by biopsy or surgery. This score measures how likely it is that the cancer will grow and spread rapidly.

This scoring refers to how cancer cells look when compared to normal prostate cells. Here are the conditions in the Gleason score:

Gleason 6 or lower, meaning the cancer cells are similar to healthy cells (low grade cancer).
Gleason 7, meaning that the cells are similar to healthy cells (medium-level cancer).
Gleason 8, 9, or 10, meaning cancer cells look very different from healthy cells (high grade cancer).

The Gleason score was then regrouped into five grades. The higher the grade, the higher the severity.

Prostate cancer stage classification

Based on the provisions above, the doctor will determine the stage of prostate cancer that you are experiencing. Just like other types of cancer, the classification of the stages of prostate cancer is divided into four levels, from the lowest to the highest or the most severe.

Stage 1

Stage 1 prostate cancer is an early stage of cancer. At this stage, cancer cells are usually slow growing and the tumor cannot be felt on a digital rectal exam (digital rectum exam /DRE) or during ultrasound. Although the tumor can be felt and seen, it is generally only small and on one side of the prostate gland.

Cancer cells have not spread to nearby lymph nodes and to other parts of the body. At this early stage, the TNM system, PSA level, and Gleason score grade are usually described as follows:

T1, N0, M0 or T2, N0, M0.
PSA level less than 10.
Grade 1 or a Gleason score of 6 or lower.

Stage 2

In stage 2 prostate cancer, the tumor is generally only in the prostate and has not spread to other parts of the body. Prostate cancer stage 2 is divided into three groups, namely:

Stage IIA

Stage IIA prostate cancer generally has a PSA level between 10-20 with a Gleason score of 6 or less (grade 1). The size of the tumor is described by one of the following conditions:

The tumor cannot be felt and can be seen on DRE or ultrasound (T1, N0, M0).
The tumor can be felt on DRE and seen on ultrasound, which is on one half or less of one side of the prostate gland (T2, N0, M0).
The tumor can be felt on DRE and seen on ultrasound, which is more than half on one side of the prostate (T2, N0, M0).

Stage IIB

In stage IIB, tumors may or may not be felt on DRE or seen on ultrasound (T1 or T2, N0, M0). The PSA level at this stage is less than 20 and generally has a Gleason score of 3 + 4 = 7 (grade 2).

Stage IIC

At this stage, the tumor may or may not be felt on DRE and seen on ultrasound (T1 or T2, N0, M0). PSA levels are below 20 with grade 3 or 4 (Gleason score 4 + 3 = 7 or 8).

Stage 3

Stage 3 prostate cancer is included in an advanced stage. At this stage the PSA level is high and the tumor has grown bigger, but has not spread to the lymph nodes and other organs. Stage 3 prostate cancer is divided into three groups, namely:

Stage IIIA: At this stage, the PSA level has reached 20 or above, with a Gleason score of 8 or less (grades 1 to 4). The tumor has grown in size, but has not spread beyond the prostate gland (T1 or T2, N0, M0).
Stage IIIB: At this stage, the PSA level can be at any point and the Gleason score is generally in grades 1 to 4 (Gleason score 8 or less). However, cancer cells have started to grow outside the prostate and may have spread to the seminal vesicles or to other tissues around the prostate, such as the rectum, bladder, and / or pelvic wall (T3 or T4, N0, M0).
Stage IIIC: At this stage, the PSA level can be any number with a Gleason score of 9 or 10 (grade 5). The size of the tumor can vary, it may or may not spread to surrounding healthy tissue (any T, N0, M0).

Stage 4

Stage 4 prostate cancer is the last stage of cancer. At this stage, the tumor generally grows bigger and may or may not grow in the tissue around the prostate. The stages of prostate cancer are divided into two groups, namely:

Stage IVA: At this stage, the PSA level and the Gleason score can be at any number. The cancer cells have also spread to the surrounding lymph nodes, but have not spread to other distant organs (any T, N1, M0).
Stage IVB: The PSA level and the Gleason score at this stage can be at any number. Spread to the surrounding lymph nodes can also occur, but it may not. However, at this latest stage, cancer cells have spread to other organs, such as bones or other organs that are more distant (no matter T, no N, M1).

End-stage or metastatic prostate cancer

Just like the nature of cancer cells in general, prostate cancer can spread to other organs. This condition is called metastatic prostate cancer and generally occurs in late stage or 4 patients.

Prostate cancer metastases can occur when cells break down from a tumor in the prostate and travel through the lymphatic system or bloodstream to other areas of the body. The organs that can be affected by this spread are generally the bones, lymph nodes, lungs, liver and brain.

However, in rare cases, prostate cancer metastases can also occur in other organs, such as the adrenal glands, breasts, eyes, kidneys, muscles, pancreas, salivary glands, and spleen.

When prostate cancer has metastasized, a person will generally experience a variety of other symptoms, in addition to the commonly felt prostate cancer symptoms. If this happens to you, you should immediately consult a doctor to get the right treatment.