TWO SYSTEMS FOR STAGING PROSTATE CANCER
Say a man’s prostate feels normal during a digital rectal exam, but his PSA is elevated and a biopsy has found cancer cells (this is considered stage Tic disease—see table 3.2). Is this significant cancer? Should action be taken? The new research suggests that for men with stage Tic disease, if any cancer is found in three needle cores, or in greater than 50 percent of any one needle core, or if the Gleason score (discussed in this chapter) is 7 or higher, then it’s highly likely that significant cancer is present in the prostate. On the other hand, if the cancer is Gleason 6 or less and is found in only one or two needle cores, cancer makes up less than half of these cores, and if the PSA density is less than 0.1 to
Table 3.2 Two Systems for Staging Prostate Cancer
Whitmore-
TNM
Jewett
Stage
Description
Stage
Description
Tla
Not palpable in a DRE; found incidentally when benign tissue is removed by TUR; 5 percent or less of the removed tissue is cancerous.
Al
Same as TNM
Tlb
Not palpable; found incidentally, but greater than 5 percent of the tissue removed by TUR is cancerous.
A2
Same as TNM
Tlc
Not palpable; identified by needle biopsy because of elevated PSA.
This category is not part of the Whitmore-Jewett system.
T2a
Palpable; involves less than half of one lobe.
BIN
Palpable; involves less than half of one lobe; is surrounded by normal tissue.
T2b
Palpable; involves more than half of one lobe, but not both lobes.
Bl
Palpable; involves less than one lobe.
T2c
Palpable; involves both lobes.
B2
Palpable; involves one entire lobe or more.
T3, T4
Palpable; penetrates the wall of the prostate and/or involves the seminal vesicles.
C
Same as TNM
N+
Has spread to lymph nodes.
Dl
Same as TNM
M+
Has spread to bone.
D2
Same as TNM
Note: These stages can be confusing; although the newer, more explicit TNM system is becoming more popular, many doctors tend to use both systems interchangeably.
0.15, there’s a good chance that the cancer in the prostate is insignificant (that there is less than 0.2 cubic centimeters of prostate cancer, and that it is confined solely to the prostate.)
Scientists at Johns Hopkins and elsewhere are also working to develop a more scientific means of prediction than the current one, which relies heavily on the human eye. Currently, much of the interpretation of cancer simply comes down to subjective guesswork, based on how hundreds of thousands of cells look under the microscope. On the horizon may be a computerized image analysis system that measures and quantifies various cell shapes and irregularities—and, in the process, creates more lucid pictures from a murky palette.
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