Grading and Staging of Prostate Cancer
Prostate cancers are graded on how closely cells in the sample look like normal cells. Cells that look very different from normal cells could mean the cancer may grow faster. The system most used for grading is the Gleason score, by which samples from two areas of the prostate are graded from 1 to 5. The numbers are added to give a score between 2 and 10. The lower this number, the more cells look like normal prostate cells. A higher score means the cancer looks less like normal cells, and is an indicator that the tumor is likely to grow more quickly.1
Following a cancer diagnosis, tests are done to see if the cancer has spread within the prostate or to other parts of the body. This is called staging, which shows the current disease stage. The doctor needs to know the stage of a cancer to plan the best treatment.1
American Joint Committee on Cancer (AJCC) TNM system is the most widely used prostate cancer staging system.10 Staging describes the severity of cancer based on the extent of the original (primary) tumor and how far it has spread in the body.10 In the TNM system,
- “T” describes the size of the tumor and whether it has spread to nearby tissue
- “N” describes any lymph nodes that are involved
- “M” describes metastasis (spread of cancer from one body part to another)18
Tests to determine a man’s stage for prostate cancer include:
Magnetic resonance imaging (MRI). This test uses a computer, radio waves, and a magnet to produce a series of detailed pictures of areas inside the body.10
CT scan. Detailed pictures are taken from different angles of areas in the body. They are generated by an x-ray machine linked to a computer. A dye may be injected into a vein, or the patient may swallow it, to help obtain clearer pictures of organs or tissues.10
Radionuclide bone scan. This shows whether or not there are rapidly dividing cells such as seen with cancer in the bones. A tiny amount of radioactive material is injected into a vein. The material moves through the bloodstream, is collected in the bones, and is detected by a scanner.10
Pelvic lymphadenectomy.(glossary) Lymph nodes are removed from the pelvis. The tissue is searched for cancer cells.10
These test results, along with those of the tumor biopsy, are viewed together to define the accurate prostate cancer stage.
Prostate Cancer Stages10
The stages of prostate cancer are:
- Stage I. Cancer cells are found only in the prostate gland and usually accidentally during surgery for other reasons. A DRE or imaging cannot detect this stage
- Stage II. This stage is more advanced than that of Stage I, but the cancer has not spread beyond the prostate
- Stage III. The cancer has spread to nearby tissues. It may be found in the seminal vesicles
- Stage IV. The cancer has metastasized, or spread, to lymph nodes near or far from the prostate or to other parts of the body such as the lungs, liver, bladder, or rectum. Metastatic prostate cancer may often spread to the bones
Indication
Trelstar® is indicated for the palliative treatment of advanced prostate cancer.
Important Safety Information
After your first injection of Trelstar®, you might feel a temporary increase in your cancer symptoms, such as pain in your bones, nerve disorder, blood in your urine, blockage in the canals leaving your bladder, or pressure in the spinal cord that may lead to weakness or paralysis with or without fatal complications. This is because the amount of testosterone in your bloodstream actually goes up for a short period after the injection. If your symptoms increase later than the first week or two following an injection, tell your doctor. The most common side effects that patients taking Trelstar® have are actually the effect of lowering testosterone levels. The most common effect of lowering testosterone is hot flushes or flashes. These are like the hot flashes women have around the time of menopause. Other side effects include bone pain, impotence (sexual side effect), tissue breakdown in the testicles, headache, leg pain, and swelling in the legs. Women who are or may become pregnant and those who are allergic to this type of drug should not take Trelstar®. A severe potentially fatal form of shock, hyper allergic response, and allergic swelling related to Trelstar® have been reported. For more information on these and other side effects, please talk to your doctor.
