Prostate Cancer Staging and Progression
Diagnosing and monitoring prostate cancer
Many tests can be used to find and monitor prostate cancer.
A number of methods can help doctors investigate problems in the prostate, stage
and grade tumors, and keep track of how cancer may be changing over time. To determine
the best treatment plan for you, your doctor may recommend several different tests.
The major diagnostic tests for prostate cancer are:
- The digital rectal exam (DRE). During this screening exam, a doctor
uses a finger (digit) to feel for any unusual features on the prostate
- The prostate-specific antigen (PSA) test. This test measures a
protein called PSA, which is produced in the prostate. It can be important for men
with advanced prostate cancer to monitor how the level of PSA is changing. A rise
in PSA level from year to year may suggest that the prostate is growing larger
- Biopsy. A sample of tissue taken with a needle is called a
biopsy. This type of sample is needed to determine if a cancer has spread from
the prostate to other organs or the lymph nodes (small, bean-shaped groups of immune
system cells). Biopsies are examined by a pathologist, a doctor who specializes
in diagnosing diseases based on tissue samples
- Lymph node biopsy. In this type of biopsy, one or more lymph
nodes is removed. Also called a lymph node dissection or a lymphadenectomy,
lymph node biopsy is performed to find out if a cancer has spread from the prostate
to nearby lymph nodes
- Radionuclide bone scan. This test uses a slightly radioactive material
to make an image of the skeleton and determine where bone tissue has been damaged
by cancer
- Computed tomography (CT or CAT scan). A CT scan is a rotating X-ray
that creates precise images
of the body
- Magnetic resonance imaging (MRI). Using radio waves and magnets,
MRI scans create detailed images
of the body
- ProstaScint™ scan. Using injections of slightly radioactive
material, ProstaScint scans help doctors look for cancers that have spread beyond
the prostate
- Genetic testing. For some men with prostate cancer, genetic testing
(tests of the genes, or DNA blueprints that tell your body how to grow) may help
in planning treatment. Talk to your doctor to see if genetic testing is right
for you
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Staging prostate cancer
Staging is a way of describing the size of a tumor and how it has spread.
You may know about cancer staging, especially if you’ve been through several
tests. Staging is essential because it helps your urologist or medical
oncologist (a doctor who specializes in fighting cancer) determine the
best treatment plan for you. Advanced prostate cancer is at stage IV.
Along with telling doctors how large a tumor is and how it has spread, staging also
involves grading, which describes how aggressive the cancer is—meaning
how fast it’s likely to grow. Most pathologists use the Gleason system
when grading prostate cancer.
In the Gleason system, pathologists assign the most common type of cancer cell in
your prostate a number between 1 and 5. The higher the number is, the more abnormal
the cells are. A second number is then assigned to the second-most common type of
cancer cell. The Gleason score is the sum of these two numbers, which will be between
2 and 10.
The stages of prostate cancer are:
Stage I
These prostate cancers are small and have low Gleason scores (2 to 4). Sometimes,
these tumors grow slowly and cause few problems. These tumors have not spread to
the lymph nodes.
Stage II
At this stage, the cancer is larger and may have a higher Gleason score, but it
hasn’t spread to the lymph nodes or other parts of the body.
Stage III
By stage III, the prostate cancer may have begun to spread to the seminal vesicles.
But it still has not spread to the lymph nodes, the bladder, the rectum,
or other organs. Stage III cancers are more likely to recur, or come back
after treatment.
Stage IV, or advanced prostate cancer
By stage IV, the cancer has advanced to other parts of the body such as the bones.
Hormone therapy, radiation, and surgery to relieve symptoms may all be considered
for treatment. Sometimes, hormone therapy stops working, and chemotherapy may become
an option.
Staging and grading are part of a total prognosis, or medical outlook.
This involves a person’s overall health and other conditions. Staging can be complicated,
so be sure to ask your doctor any questions you have about it.
The TNM system of staging
What system do doctors use when staging prostate cancer?
The stages described here are based on a complex method commonly used by doctors
to describe cancers. This is called the Staging System of the American Joint Committee
on Cancer, or the TNM system (tumor, node, metastasis). The TNM system involves
3 scores that describe:
- The tumor type
- Whether or not lymph nodes are involved
- How far the cancer has spread
Primary tumor (T)
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T0
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There is no evidence of a tumor
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T1
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The tumor cannot be seen without using imaging techniques
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T2-4
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The higher numbers indicate the size and extent of the primary tumor. At T2, the
tumor is still in the prostate. At T3, the tumor may have spread to the seminal
vesicles. And at T4, the tumor has grown beyond the prostate
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Nodes (N)
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N0
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The cancer has not spread to the lymph nodes
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N1
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The cancer has spread to the lymph nodes
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Metastasis (M)
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M0
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No distant metastasis, meaning the cancer has not spread beyond the regional
lymph nodes
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M1
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Distant metastasis, meaning the cancer has spread to other organs
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IMPORTANT SAFETY INFORMATION FOR JEVTANA® (CABAZITAXEL) INJECTION
WARNING
JEVTANA may cause serious side effects, including low white blood cells. Low
white blood cells can cause you to get serious infections, and may lead to death.
The earliest sign of infection may be fever, so tell your doctor right away if you
have a fever. People who are 65 years or older may be more likely to have these
problems. JEVTANA should not be given to patients with low white blood cell counts.
Your doctor:
- Will do blood tests regularly to check your white blood cell counts during
your treatment with JEVTANA
- May lower your dose of JEVTANA, change how often you receive it, or stop
JEVTANA until you have enough white blood cells
- May prescribe a medicine for you to help prevent complications if your white
blood cell count is too low
JEVTANA can also cause severe allergic reactions. Severe allergic reactions
can happen within a few minutes after your infusion of JEVTANA starts, especially
during the first and second infusions. Your doctor should prescribe medicines before
each infusion to help prevent severe allergic reactions.
- Symptoms of severe allergic reactions may include rash or itching, skin
redness, feeling dizzy or faint, breathing problems, chest or throat tightness,
swelling of face. Tell your doctor right away if you have any of these symptoms.
Your doctor will stop your JEVTANA treatment right away and treat your allergic
reaction.
You should not take JEVTANA if you have had a severe allergic reaction to JEVTANA
or other medicines that contain polysorbate 80. Ask your doctor if you are not sure.
JEVTANA can also cause gastrointestinal symptoms.
Nausea, vomiting and diarrhea can happen when you take JEVTANA. Severe vomiting
and diarrhea with JEVTANA can lead to loss of too much body fluid (dehydration),
or too much of your body salts (electrolytes). Death has happened from having severe
diarrhea and losing too much body fluid or body salts with JEVTANA. Tell your doctor
if you have vomiting or diarrhea. Your doctor will prescribe medicines to prevent
or treat vomiting and diarrhea, as needed with JEVTANA. You may need to go to the
hospital for treatment.
Kidney failure may happen with JEVTANA.
Kidney failure may happen because of severe infection, loss of too much body fluid
(dehydration), or for other reasons, which may lead to death. Your doctor will check
you for this problem and treat you if needed. Tell your doctor if you develop:
- Swelling of your face or body
- Decrease in the amount of urine that your body makes each day
Before receiving JEVTANA, tell your doctor if you:
- had allergic reactions in the past
- have kidney or liver problems. JEVTANA should not be given to patients with liver
problems (hepatic impairment)
- are age 65 or older as these patients:
-
— may be more likely to experience certain adverse reactions, including low
white blood cell count
with or without fever, tiredness, weakness, fever,
dizziness, urinary tract infection and
dehydration
- have any other medical conditions
- if you are female and:
- — are pregnant or plan to become pregnant as JEVTANA can harm your unborn
baby
- — are breastfeeding or plan to breastfeed
Serious side effects of JEVTANA include low white blood cell counts
that could lead to serious or life-threatening infections, severe allergic reactions,
gastrointestinal symptoms (nausea, severe vomiting and diarrhea) that could lead
to death, and kidney failure.
Common side effects of JEVTANA include:
- Low white blood cell count
- Low red blood cell count (anemia). Symptoms of anemia include shortness
of breath and tiredness
- Low blood platelet count. Tell your doctor if you have any unusual
bruising or bleeding
- Tiredness
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Weakness
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- Blood in the urine
- Back pain
- Decreased appetite
- Fever
- Shortness of breath
- Stomach (abdominal) pain
- Change in your sense of taste
- Cough
- Joint pain
- Hair loss
- Numbness, tingling, burning or decreased sensation in your hands or feet
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Tell your doctor if you have any side effect that bothers you or that does not go
away. These are not all the possible side effects of JEVTANA. For more information,
ask your doctor or pharmacist. You may report side effects to FDA at
1-800-FDA-1088.
Remember, your doctor is the single best source of information regarding your
health. Please consult your doctor if you have any questions about your health or
your medicine.
For more information, go to www.sanofi.us
or call 1-800-633-1610.
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