Prostate cancer – Classification of disease stage
Prostate cancer – Classification of disease stage, Prostate cancer (prostate carcinoma) is a malignant tumor of the prostate gland. Since they are usually formed in the external region of the gland, far from the urethra, and therefore do not cause any problems, they often remain unnoticed for a long time. To constrict the urethra with disturbances during the watering, it comes only when the tumor is already large and has spread.
As the size increases, the tumor grows beyond the capsule and also affects the seminal bubbles, the bladder neck, or adjacent tissues. It then spreads over the lymphatics and nodes and typically forms daughter tumors (metastases) in the bones , which can cause pain and bone fractures.
The sooner a prostate carcinoma is discovered and treated, the better the healing chances. In particular when the tumor is still limited to the prostate gland and no tumor cells are found in adjacent tissue or lymph nodes, the disease can be cured by surgery or radiation . If there are already metastases , medicines are used to stop the disease process, to extend the lifetime and to alleviate symptoms.
How a prostate carcinoma is treated depends on its classification, ie the association to a disease stage. The classification, also known as staging, takes place according to the so-called TNM system, which is used for many cancer diseases. Three criteria are relevant:
- Size and extent of the tumor (T)
- Involvement of the lymph nodes (N)
- Presence of metastases (M)
The numbers behind the letters indicate the extent of the tumor (T1 – 4), the number and position of the affected lymph nodes (N0 and N1) and the presence or absence of distant metastases (M0 and M1).
- TNM classification of prostate cancer
- tumor extension
- Tumor is neither palpable nor visible through imaging
- Tumor in less than 5% of the biopsy tissue
- Tumor in more than 5% of the biopsy tissue
- Tumor was diagnosed after increased PSA by a needle biopsy
- Tumor limited to prostate capsules (localized carcinoma)
- Tumor in less than 50% of a lateral lobe
- Tumor in more than 50% of a side lobe
- Tumor in both sides
- Tumor grows beyond prostate capsules (locally advanced carcinoma)
- Tumor spreading on one or both sides beyond the prostate capsule;
- Tumor spread on one or both sides beyond the prostate capsule and in seminal vesicles
- Tumor spread in neighboring structures or non-displaceable (fixed)
- Lymph node metastases (N)
- No metastases in adjacent (regional) lymph nodes (pelvic lymph nodes)
- Metastases in neighboring lymph nodes
- Remote metastases (M)
- No distant metastases can be detected
- Distant metastases
- Metastases in non-adjacent lymph nodes
- bone metastases
- Metastases in other organs and / or structures
- Grading, Gleason score and risk groups
In addition to the TNM classification, the tumor is graded according to its aggressiveness (“grading”), since this provides important information for the prognosis of the disease and the choice of therapy .
On the basis of prostate tissue taken during biopsy or surgery , the pathologist examines the extent to which the tumor cells differ from normal, healthy cells – in other words, how they are already de-differentiated. For the grading of the prostate carcinoma The Gleason score , named after its inventor, was internationally applied.
In this case, two tumor cell lamellas visible in a tissue sample are subdivided into five different differentiation groups and evaluated with points of 1 and 5. The lower the assigned point value, the more likely the tumor tissue resembles normal prostate tissue. The two numbers of the cells are then added, For example, 3 + 4 gives the Gleason score 7. If the Gleason score is below 7, the forecast is rather favorable. If the score is above 7, however, the forecast is rather unfavorable.
In the case of a locally limited prostate cancer (T1-2), a classification according to the risk of recurrence is also made, since the decision about some treatments is recommended depending on the assignment in risk groups. For example, this helps to determine whether the disease is developing or whether radical prostatectomy or radiation therapy should be carried out immediately.
The assessment of recurrence risk is based on a combination of Gleason score, T-category and PSA score of the patient:
- Low risk: PSA ≤ 10 ng / ml and Gleason score 6 and cT category <2a
- Intermediate (mean) risk: PSA> 10 ng / ml to 20 ng / ml or Gleason score 7 or cT category 2b
- High risk: PSA> 20 ng / ml or Gleason score ≥ 8 or cT category 2c
The more risk factors (grading, T-category, PSA value), the more unfavorable is the prognosis for the patient. That is, the more likely
it is that the disease progresses, that metastases occur and the patient can no longer be cured.