Diagnosis and Staging of Prostate Cancer
by Beth G. Hodges, MD

Diagnosis of prostate cancer is made by biopsy. Small needles are inserted into suspicious areas of the gland under ultrasound, usually right in the doctor's office. Samples are removed and sent to a pathologist to evaluate for cancer.

There really are no early symptoms of prostate cancer, so a man usually gets to this procedure due to a lump felt in the prostate during an annual digital rectal exam or due to an elevation of prostate specific antigen (PSA.)

Once cancer is confirmed, the pathologist, by looking at the cancer cells, assigns the disease numbers, called the Gleason grading system. A score of 1 means the cells are almost but not quite normal prostate cells in appearance. The scale goes up to 5, which indicates very abnormal and aggressive appearing cells. The pathologist assigns 2 scores, and the added scores are the Gleason sum. Urologists and radiation oncologists and medical oncologists use these numbers to help guide the patient to the appropriate treatment. A higher score means a more aggressive cancer, which necessitates more aggressive therapy.

Staging of the cancer is a separate issue and speaks to the areas of the body involved or the advancement of the disease.

• Localized cancer is limited to the prostate gland itself and has the best prognosis for cure.
• Locally advanced cancer indicates there has been a small amount of cancer spread into the surrounding tissues.
• Metastatic disease, which carries the poorest prognosis, indicates the cancer has spread beyond the local area to other parts of the body, usually through the lymph nodes. Metastatic disease can be evaluated through CT scans, bone scans, and sampling of area lymph nodes.

Involved physicians will put the Gleason scores together with the cancer staging and use this data to advise the patient on therapy options.

Published - October, 2009