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A diagnosis of prostate cancer can strike fear into the hearts of a man and his family, but this need not be the case. Prostate cancer is one of the most slow-growing cancers, and it responds well to treatment. The American Cancer Society says that over 20 million men in the United States that have had the disease are still alive today. Survival rates have been improving, and according to recent data, including all men with prostate cancer, the relative 5-year survival rate is almost 100% and the relative 10-year survival rate is 91%. These numbers are due to improved methods of detecting and treating the disease and research is ongoing to continue this positive trend.
Prostate cancers that are found when they are small and before they have spread outside the gland usually respond well to treatment, and they are generally easier to remove or eradicate. The two diagnostic procedures that provide the most effective screening are the digital rectal examination (DRE) and the prostate-specific antigen (PSA) tests. If a physician performs these tests and sees questionable results from either one, further tests such as transrectal ultrasound and a biopsy of the prostate will be ordered to confirm the diagnosis.
The process of diagnosing prostate cancer includes grading and staging of the disease. Cancer grading is a system used to assess the aggressiveness of the cancer cells. Grading aids in predicting long-term results, how a patient will respond to treatment, and survival. The most common scale used to grade prostate cancer is the Gleason scale. This system has three parts: 1) the cancer cells are analyzed, 2) the two most common cancer cell patterns are each given a score from 1 to 10, and 3) those two numbers are combined to give a total score (ie, 3 + 5 = 8). There are 3 levels of scoring. A Gleason score of 4 or less is designated as “low grade.” These cancers are slow growing, the cells are most like normal prostate cells, and it is the least aggressive. A Gleason score between 4 and 7 is designated as “intermediate grade.” This cancer is the most common of the three, falling somewhere between the low- and high-grade cancers. This cancer can act like either a high- or low-grade cancer, depending on tumor volume and PSA levels. A Gleason score between 8 and 10 is designated as “high-grade.” This cancer has the highest rate of abnormal prostate cells, and is extremely aggressive. This grade grows quickly and spreads into the surrounding lymph nodes and bones. It can be very difficult to treat, and has a high recurrence rate.
The last step in diagnosing prostate cancer is staging. Cancer staging describes the size and location of the cancer. A system called TNM is used to grade prostate cancer. The “T” refers to a description of the tumor, and different numbers are used to explain the tumor size. For example, a Stage T1 designation means that the tumor is confined to the prostate and can only be observed microscopically (ie, undetectable by a DRE or ultrasound).
The “N” stands for nodes, and a number is added to show whether it has spread to the lymph nodes. For example, a Stage N0 designation means that the cancer cells have spread, but not to the lymph nodes.
The “M” stands for metastatic, and a number is added to represent the extent cancer has spread throughout the body. For example, a Stage M0 designation means that cancer cells have spread, but only regionally, and haven’t grown outside the pelvic area. Letters are added to the TNM system to provide a more elaborate description of the cancer.