Prostate cancer is the second most commonly diagnosed cancer in males, only behind skin cancer. In 2022 over 1.4 million new cases of prostate cancer will be diagnosed worldwide.
Prostate cancer tends to progress slowly and less aggressively than many other types of cancer. If you detect prostate cancer in the early stages, there’s a very high chance of survival. In the United States, the 5-year survival rate with prostate cancer is close to 98 percent.
Prostate cancer can be classified into four different stages, depending on how advanced it is.
In the first stage, the tumor is only affecting your prostate and hasn’t spread to other tissues. At stage 4, the tumor has spread to tissue beyond the prostate and possibly to distant parts of your body.
How Prostate Cancer is Diagnosed and Staged?
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the American Joint Committee on Cancer’s TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, they’ll consider several other factors as well, including:
- Prostate-specific antigen (PSA) levels
- Gleason prostate cancer score
- Grade groups
PSA Levels
PSA is a protein made by both normal and cancerous cells in your prostate. A higher PSA level in the blood is associated with an increased risk of developing prostate cancer. Many doctors will send you for further testing if your PSA levels are higher than 4 ng/mL.
According to the American Cancer Society, if you have a PSA level between 4 and 10 ng/mL, there’s a 25 percent chance you have prostate cancer. If your PSA level is above 10 ng/mL, there’s a more than 50 percent chance of having prostate cancer.
Doctors commonly use PSA testing to screen for prostate cancer, although there has been some controversy to this approach. The American Urological Association currently recommends PSA screening for the following groups:
- Average-risk individuals between the ages of 55 and 69
- Patients with a family history or other risk factors for prostate cancer
Doctors also commonly use a digital rectal exam, where they use a gloved finger to feel for abnormal prostate growth. Additional blood tests and an MRI of the prostate to look for lesions might also be done.
If your doctor finds anything unusual on these tests, they may request a biopsy. During a biopsy, your doctor will collect a tissue sample from your prostate. The sample will be studied under a microscope to check for signs of cancer.
Gleason Prostate Cancer Score
Dr. Donald Gleason originally developed the Gleason prostate cancer score in the 1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and don’t resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
Gleason Score vs. Grade groups
The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.
One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:
- 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered “favorable” intermediate risk.
- 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered “unfavorable” and may mean local or metastatic spread.
So, although both situations give a Gleason score of 7, they actually have very different prognoses.
Following overview of how the two grading systems compare:
| Cancer grade | Grade group | Gleason score |
|---|---|---|
| Low to very low-grade | Group 1 | < 6 |
| Intermediate | Grade group 2 | 7 (3 + 4) |
| Intermediate | Grade group 3 | 7 (4 +3) |
| High to very high-grade | Group 4 | 8 |
| High to very high-grade | group 5 | 9–10 |
Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.
Stage-1 Prostate Cancer
Stage-1 is the least advanced form of prostate cancer. Cancer in this stage is small and hasn’t spread past the prostate gland. It’s characterized by a PSA of less than 10 ng/mL, a grade group score of 1, and a Gleason score of 6.
Stage 1 prostate cancer has a 5-year survival rate of nearly 100 percent.
Treatment
Active surveillance has become the recommended management strategy for nearly all patients with a Gleason score of 6, except those with very high-volume disease and those who are unwilling or unable to undergo additional biopsies. Active surveillance means monitoring the cancer over time to see if further treatment is needed.
Another treatment option is a radical prostatectomy, which is surgical removal of the prostate gland. Radiation therapy may also be recommended, either by itself or with prostate removal.
Stage-2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasn’t spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still near 100 percent.
The PSA score for stage-2 is less than 20 ng/mL.
Stage-2 prostate cancer is further divided into three phases depending on the grade group and Gleason scores:
- Grade group: 1
- Gleason score: 6 or less
Stage-2B
- Grade group: 2
- Gleason score: 7 (3 + 4)
Stage-2C
- Grade group: 3 or 4
- Gleason score: 7 (4 + 3) or 8
Treatment
Treatment options at stage-2 include the following:
- Removing your prostate and possibly some surrounding lymph nodes
- Hormone therapy which is combined with radiation therapy in select patients (grade group 3 or those who have greater than 50 percent positive biopsy cores)
- Radiation therapy in the form of external beam and/or brachytherapy for select patients
- Active surveillance is generally only offered for stages 2A and 2B
Stage-3 Prostate Cancer
At stage-3, cancer cells may or may not have spread outside the prostate to other tissues. The survival rate of prostate cancer that hasn’t spread to distant parts of your body is still close to 100 percent.
As in stage-2, stage 3 prostate cancer is broken down into three letter subgroups.
Stage-3A
In this stage, cancer hasn’t spread outside of your prostate or to any lymph nodes.
- Grade group: 1 to 4
- Gleason score: 8 or less
- PSA: 20 ng/mL or higher
Stage-3B
Prostate cancer at this stage has grown outside your prostate and may have spread to your seminal vesicles or other surrounding tissue. It hasn’t spread to lymph nodes or to other parts of the body.
- Grade group: 1 to 4
- Gleason score: 8 or less
- PSA: any level
Stage-3C
The cancer may or may not be growing outside your prostate, such as the lymph nodes or other nearby organs.
- Grade group: 5
- Gleason score: 9 or 10
- PSA: any level
Treatment
Treatment options at stage 3 include the following:
- External beam radiation plus hormone therapy
- Radiation (external beam and brachytherapy) plus hormone therapy
- Radical prostatectomy, usually with removal of the pelvic lymph nodes; radiation therapy and/or hormone therapy may follow
Active surveillance is typically not an option for stage 3 disease due to risk of disease progression without treatment.
Stage-4 Prostate Cancer
Stage-4 is the most advanced stage of prostate cancer and is divided into two letter groups. Stage-4 prostate cancer can have any grade group, PSA value, and Gleason score.
By stage-4, cancer has typically spread to distant parts of your body. If it has spread to other organs, the 5-year survival rate drops to about 30 percent.
Following are the subcategories of stage 4 prostate cancer.
Stage-4A
The tumor has spread to nearby lymph nodes but nowhere else in the body.
Stage-4B
The cancer may have spread to distant lymph nodes, as well as other parts of the body such as other organs or bones.
Treatment
Treatment options at the stage-4 include the following:
- Chemotherapy
- External beam radiation
- Hormone therapy
- Prostate removal or surgery
- radiation targeting bones (if the cancer has spread to bone tissue)
Bay Biosciences is a global leader in providing researchers with high quality, clinical grade, fully characterized human tissue samples, bio-specimens, and human bio-fluid collections.
Samples available include cancer (tumor) tissue, cancer serum, cancer plasma, cancer, peripheral blood mononuclear cells (PBMC). and human tissue samples from most other therapeutic areas and diseases.
Bay Biosciences maintains and manages its own biorepository, the human tissue bank (biobank) consisting of thousands of diseased samples (specimens) and from normal healthy donors available in all formats and types.
Our biobank procures and stores fully consented, deidentified and institutional review boards (IRB) approved human tissue samples and matched controls.
All our human tissue collections, human specimens and human bio-fluids are provided with detailed, samples associated patient’s clinical data.
This critical patient’s clinical data includes information relating to their past and current disease, treatment history, lifestyle choices, biomarkers, and genetic information.
Patient’s data is extremely valuable for researchers and is used to help identify new effective treatments (drug discovery & development) in oncology, and other therapeutic areas and diseases.
Bay Biosciences banks wide variety of human tissue samples and biological samples, including cryogenically preserved at – 80°C.
Including fresh frozen tissue samples, tumor tissue samples, formalin-fixed paraffin-embedded (FFPE), tissue slides, with matching human bio-fluids, whole blood and blood-derived products such as serum, plasma and PBMC.
Bay Biosciences is a global leader in collecting and providing human tissue samples according to the specified requirements and customized, tailor-made collection protocols.
Please contact us anytime to discuss your special research projects and customized human tissue sample requirements.
Bay Biosciences provides human tissue samples (human specimens) from diseased and normal healthy donors which includes:
- Peripheral whole-blood
- Amniotic fluid
- Bronchoalveolar lavage fluid (BAL)
- Sputum
- Pleural effusion
- Cerebrospinal fluid (CSF)
- Serum (sera)
- Plasma
- Peripheral blood mononuclear cells (PBMC)
- Saliva
- Buffy coat
- Urine
- Stool samples
- Aqueous humor
- Vitreous humor
- Kidney stones (renal calculi)
- Other bodily fluids from most diseases including cancer.
We can also procure most human bio-specimens, special collections and requests for human samples that are difficult to find. All our human tissue samples are procured through IRB-approved clinical protocols and procedures.
In addition to the standard processing protocols, Bay Biosciences can also provide human plasma, serum, and PBMC bio-fluid samples using custom processing protocols; you buy donor-specific collections in higher volumes and specified sample aliquots from us.
Bay Biosciences also provides human samples from normal healthy donors; volunteers, for controls and clinical research, contact us Now.
日本のお客様は、ベイバイオサイエンスジャパンBay Biosciences Japanまたはhttp://baybiosciences-jp.com/contact/までご連絡ください。