Okay, the biopsy is positive, and the diagnosis is prostate cancer. But what does this mean? The next step is to determine the stage—how far the cancer has spread—and the grade—how the cancer cells look, as an estimation of how fast they’re growing.
Setting the Stage for Treatment
There are two different ways to classify prostate cancer: The Whitmore-Jewett system, and the TNM staging system. They are based on the extent to which the cancer has grown. Is it confined to the prostate? Or has it spread, and if it has, how far? Again, the staging system drives home the vital message that early diagnosis is fundamental to a cure—because prostate cancer is considered curable only in its earliest stages, when it’s confined to the prostate.
The best-case scenario is when unsuspected cancer cells are not palpable (large enough for a doctor to feel during a digital rectal exam) and are found incidentally—when tissue is removed during a TUR procedure, for example, a doctor orders a biopsy to investigate an elevated PSA score. (In a TUR, or transurethral resection of the prostate, a procedure to treat symptoms of an enlarged prostate, overgrown prostate tissue is removed in fragments through the urethra. These bits of tissue are routinely sent to a pathologist for evaluation.) Other, less congenial cancers are found during a physical exam, when a doctor’s gloved finger detects a lump or aberration—a small nodule on one or both sides of the prostate. The next category is cancer that has penetrated the wall of the prostate or invaded the nearby seminal vesicles.
Generally, the higher the letter, the worse the cancer. Cancer in the highest stages (D, N, or M) means the tumor has metastasized—a chunk of cancer has broken off and established itself in another location, generally in a nearby lymph node. The most serious stage is when cancer has infiltrated other lymph nodes and spread to distant regions, most commonly to bone. Cancer at these stages can be controlled and even kept at bay for months or even years, but not cured. And nobody, as yet, understands why this is—what critical changes take place when the cancer leaves the prostate, and why, suddenly, it defies the treatment that can be so effective in its earlier phases.
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