Diagnosis | Treatment

Staging Prostate Cancer

Once prostate cancer has been found in a biopsy, the next step is to determine the cancer's stage, how large the tumor is and how far it has spread. These findings will form the basis for decisions about how to most effectively treat the disease. Therefore, additional information must be gathered to form as complete a picture as possible of the size and extent of the cancer, without surgical intervention.

Two types of staging are used to describe prostate cancer.

• The clinical stage is determined by information that can be gathered without surgery: from the PSA level, the digital rectal examination (DRE) , the transrectal ultrasound and the prostate biopsy. In selected cases, when cancer is suspected to have spread outside the prostate gland, additional information may be gathered from imaging studies or lymph node dissection.
• The pathologic stage is based on the surgical removal and examination of the entire prostate gland, the seminal vesicles and surrounding structures and, on occasion, pelvic lymph nodes.

The TNM System is the most widely used staging system in the United States. It describes the extent of the primary tumor (T stage), the absence or presence of spread to nearby lymph nodes (N stage) and the absence or presence of metastasis (M stage).

Knowing the cancer's stage is important because this information is used to make treatment decisions. However, the clinical stage may underestimate the extent of cancer spread. The pathologic stage, determined after radical prostatectomy (surgical removal of the prostate gland and surrounding structures), is more accurate in predicting the patient's outlook for survival. A pathologic stage cannot be definitively determined for men who do not undergo this surgery. However, the Partin Coefficient Tables provide a mechanism for predicting pathologic stage based on PSA value, Gleason score and clinical stage.

More information:

• Evaluation for Distant Disease: Imaging Tests
  
• Lymph Node Dissection
  
• The TNM Staging System
  
• Predicting Pathologic Stage: The Partin Coefficient Tables
  

The Prostate Cancer pages of this Web site are part of the Comprehensive Prostate Cancer Awareness Program (CPCAP), a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.

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