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When prostate cancer is diagnosed, the stage that it has reached is an important indicator of its survivability, and will also influence the treatment choices that are made for that patient.
There are four stages, which may be expressed as Stages 1 through 4, or A to D.
Stage 1 is relatively rarely diagnosed. At this stage, the cancerous tumor is not yet large enough to have been picked up by a digital rectal examination or even by imaging. Instead, Stage 1 cancers are often found when other prostate surgery, for instance for benign prostatic hyperplasia, is being carried out. They may also be found through a blood test. At this stage, surgical removal of the prostate gland may be advised, and radiation therapy may also be used to ensure the cancer is eradicated.
At Stage 2, the cancer has not moved outside the prostate gland or affected other organs of the body, though it has grown to the size at which it can be detected by a rectal examination. Cancers detected at Stage 1 and 2 have above 65 percent survivability (to 5 years after diagnosis) and correct treatment can raise survival rates as far as 98 percent.
Treatment for Stage 2 prostate cancer will probably involve radical prostatectomy, that is, surgical removal of the prostate gland, together with radiation therapy. Radiation therapy can be external, which is administered in a similar way to x-rays, or internal (also known as brachytherapy), in which radioactive ’seeds’ are implanted within the prostate to target the pinpointed area with radiation. Hormone therapy may also be used to reduce testosterone levels, and thereby reduce the rate at which the cancer is growing. A combination of therapies generally has better results than the application of a single therapy.
In Stage 3, the cancer has spread beyond the prostate gland to affect nearby tissues, but has not reached the bladder or lymph nodes. Surgery and radiation therapy are generally used in combination with hormone therapy, with survival rates as high as 80 percent where a combination of therapies is used.
Stage 4 prostate cancer is diagnosed where the cancer has spread to other locations in the pelvic area (eg the lymph nodes) or the bones. By this stage the survival rate has fallen to 30 percent – however, combined modality therapy is said to be able to more than double the chances of survival. Only about a quarter of diagnoses of prostate cancer have reached this stage, and that proportion appears to be falling as more men come forward for testing at an earlier stage.
Metastatic prostate cancer often spreads to the bones – this can be detected by a bone scan. The cancer may also have spread to the rectum, bladder, liver or lungs. Radical surgery may be used including the removal of both testicles (orchidectomy) as well as of the prostate gland. Radiation and hormone therapy may also be combined. In some cases, a transurethral resection of the prostate may be used purely as a palliative treatment to relieve pain and difficulties in urination that are caused by the cancer.
Diagnosing the correct stage of prostate cancer may involve extra tests to see whether the cancer has spread or metastasized. It is important that the correct diagnosis is made, so that the best mix of treatment can be administered for the particular patient.
The earlier the diagnosis is made, the better the patient’s chances of a quick and successful treatment of the cancer. This is why regular checks are advised for men in their 50s and above, particularly for those of sub-Saharan African descent and for those with a family history of prostate cancer.