Staging

What happens next? 

When men are told that they have prostate cancer it is sometimes very hard to remember all of the information that they have been given and they may get confused as to what treatment may be available. Sometimes it will not be able to determine the sort of treatment that is appropriate for a man’s situation until further investigations such as an MRI or bone scan (see below) have been performed to ascertain whether the cancer is localised to the prostate gland or is affecting other areas. At the time of a man’s diagnosis they should meet and be given the contact details of a Clinical Nurse Specialist (CNS) .The CNS will usually be able to supply men with information relating to their individual situation and help guide them through possible treatment options. They will also act as a Keyworker and point of contact for men during their treatment journey.

Deciding Treatment

The type of treatment that a man may receive for prostate cancer will depend on a number of different factors. Below is a summary of some of the factors which will be taken into account.

The tissue analysis of the biopsy will identify whether cancer is present in one or more areas of the prostate and in what amount or percentage. This is important as it will help decide how much treatment may be needed.

The biopsy samples taken from the prostate gland during the TRUS biopsy will be sent off to the laboratory to be analysed for the presence of any cancer. This is performed by medical scientists called pathologists. They will look at the tissue from the biopsy under a microscope and check for the presence of specific cancerous cells.

 

Gleason Grading

If prostate cancer is found to be present it will be evaluated using a special system called the Gleason grading system. This is the standard means of classifying prostate cancer and can give an accurate picture of how potentially aggressive or problematic prostate cancer that is present may be (see diagram below).

Please note that this information relates to the most common type of prostate cancer called adenocarcinoma of the prostate gland.

A review of all of the biopsy and scan results will also enable a clinical stage to be identified for instance whether it is confined within the prostate or has spread outside. A clinical stage of prostate cancer can be classified using a system called the TNM system, where T stands for Tumour size, N stands for lymph nodes and M stands for metastases (spread of cancer to other organs or bones).

T1

The cancer is at an early stage and is not obvious on examination of your prostate indicating localised prostate cancer.

T2

Cancer can be felt on examination of your prostate on either one or both lobes of the prostate again indicating localised prostate cancer.

Sub category;

T2a  Tumour involves half of a prostate lobe or less,

T2b  Tumour involves more than half of a prostate lobe, but not both lobes,

T2c Tumour involves both lobes.

T3

The cancer can be felt on the surface of the prostate which may indicate it has extended beyond the capsule of the prostate or to the surrounding seminal vesicles.

Sub category;

T3a Cancer has spread to capsule of the prostate on one side of the prostate

T3b Cancer has spread to the capsule of the prostate on both sides,

T3c   Tumour invades seminal vesicle(s)

T4

The cancer has spread beyond the prostate to the neck (beginning of the bladder) the rectum (back passage) and is likely to have spread to other areas of your body.

 

Prostate T

N is for Lymph Nodes

The human body is covered by a special type of drainage system called the lymphatic system. This system is responsible for transporting excess fluid from the organs and tissues of the body in a fluid called lymph. Lymph fluid will contain various types of cells and substances that are no longer needed. The lymph fluid will be transported through the lymphatic drainage system and pass through small nodules or nodes that act as filters. They are responsible for filtering out these unwanted substances. Cancerous cells which break off from the an organ which has cancer and can also travel along this route and become trapped at the lymph nodes where they can then infiltrate a new area of the body. The diagram below shows the lymphatic drainage system.

Lymph Nodes

 

NX

Lymph nodes not measured

N0

Lymph nodes do not contain cancer

N1

Lymph nodes contain cancer

M is for Metastases-whether or not the cancer has spread to other areas of the body such as other organs or bones.

MX

Spread of cancer not measured

M0

No evidence of cancer spread to other areas of the body

M1

Clear evidence that cancer has spread to other areas of the body

An example of using the above system would be for instance, T2 N0 M0. This would mean that the cancer is localized to the prostate gland. T3 N1 M0 would mean that prostate cancer has spread outside of the prostate and has affected at least one lymph node.

Cancer that is confined to the prostate is called localised prostate cancer while cancer that has broken through or onto the surface of the prostate gland (outside of the prostate) is called locally advanced disease. Cancer that has spread outside of the prostate to other organs or bones is called metastatic prostate cancer

 

 

I have been told that I need to have “staging scans” to find out if the cancer has spread. What are they?  

 

 

Staging scans will usually comprise an MRI scan or a bone scan or sometimes both. An MRI scan uses magnets to form pictures of the inside of the body and can be used to identify any prostate cancer that has spread to the seminal vesicles or lymph nodes, For more information on how an MRI scan is performed please follow this link  Some men may not able to have an MRI scan for instance if they have a pacemaker. A  CT scan may be performed instead. If men are claustrophobic it may be possible for them to have an “open” MRI or CT scan. However this may not be available locally and means that they may need to travel to a specialist cente. Alternatively it may be possible to liaise with the healthcare team or GP and discuss the possibility of taking a mild relaxant medication prior to undergoing the procedure.

A bone scan involves the injection of a radioactive dye into the arm which will take about 4 hours to circulate around the body. Once it has circulated it will settle in the bones. A special camera will then be used to take pictures of the skeleton and bone structure to identify any areas of bone that may have been affected by prostate cancer. A bone scan can also identify previous trauma, fractures or arthritis that are present and sometimes it can be difficult to distinguish whether abnormalities are cancerous or non-cancerous. In these instances it may be recommended that men have a “comparison” X-ray of the site. This does not mean that cancer has definitely spread to the bones but will allow specialist X-ray doctors to compare the region more accurately with the bone scan.

 

 

Last review November 2019. Next review November 2020.

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