Doctor Healthy: PROSTATE CANCER STAGING

TUMOR

TX: The primary tumor cannot be evaluated.
T0: There is no evidence of a tumor in the prostate.
T1: The tumor cannot be felt during the DRE and is not seen during imaging (any test that produces pictures of the inside of the body, such as a CT scan). It may be found when surgery is done for another reason, usually for BPH, or abnormal growth of benign prostate cells.
T1a: The tumor is in 5% or less of the prostate tissue removed through surgery.
T1b: The tumor is in more than 5% of the prostate tissue removed through surgery.
T1c: The tumor is found during a needle biopsy, usually because the patient has an elevated PSA level.
T2: The tumor is found only within the prostate, not other areas of the body. It is large enough to be felt during the DRE.
T2a: The tumor has invaded one-half of one lobe (part or side) of the prostate.
T2b: The tumor has spread to more than one-half of one lobe of the prostate, but not to both lobes.
T2c: The tumor has invaded both lobes of the prostate.
T3: The tumor has grown through the prostate capsule (into the tissue just outside the prostate on one side).
T3a: The tumor has grown through the prostate capsule either on one side or on both sides of the prostate or has spread to the neck of the bladder.
T3b: The tumor has invaded the seminal vesicle(s), the tube(s) that carry semen.
T4: The tumor is fixed, or it is invading nearby structures besides the seminal vesicles, such as the external sphincter (part of the muscle layer that helps to control urination), the rectum, levator muscles, and/or the pelvic wall.

NODES

NX: The regional lymph nodes cannot be evaluated.
N0: The cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to the regional lymph node(s).

DISTANT METASTASIS

MX: Distant metastasis cannot be evaluated.
M0: The disease has not metastasized.
M1: There is distant metastasis.
M1a: The cancer has invaded nonregional, or distant, lymph node(s).
M1b: The cancer has invaded bone(s) in the body.
M1c: The cancer has spread to another part of the body, with or without spread to the bone.

PROGNOSTIC FACTORS
PSA-GLEASON SCORE-STAGE

GLEASON SCORE

Gleason X: The Gleason score cannot be determined.
Gleason 6 or lower: The cells are well-differentiated.
Gleason 7: The cells are moderately differentiated.
Gleason 8, 9, or 10: The cells are poorly differentiated or undifferentiated .

STAGE GROUPING

Stage	T	N	M
I	T1a, T1b, or T1c	N0	M0
	T2a	N0	M0
	Any T1 or T2a	N0	M0
IIA	T1a, T1b, or T1c	N0	M0
	T1a, T1b, or T1c	N0	M0
	T2a	N0	M0
	T2b	N0	M0
	T2b	N0	M0
IIB	T2c	N0	M0
	Any T1 or T2	N0	M0
	Any T1 or T2	N0	M0
III	T3a or T3b	N0	M0
IV	T4	N0	M0
	Any T	N1	M0
	Any T	Any N	M1

First aid

First aid is a complicated subject and it is situation-specific. First aid is the help and medical assistance that someone gives, not only to an injured person, but to a person who is sick. Preparedness is a key element of first aid, like having basic medical emergency kits in your home, car, boat, or RV. It is also advised to be prepared for illness while traveling locally or to a foreign country. Cuts, puncture wounds, sprains, strains, nosebleeds are one type of injury that may require first aid; heart attacks, strokes, seizures, and heat stroke are examples of more critical first aid emergencies.

Making Decisions About Cancer Treatment

fter a diagnosis of cancer, patients and their families must make a number of decisions about cancer treatment, some of which are more difficult than others. These decisions are complicated by unfamiliar words, various statistics, and a sense of urgency. However, it is important to allow time to research your options and ask questions. Decisions about cancer treatment are personal, and it is important that you feel comfortable about your decisions.

Learn about your cancer. Try to understand as much as you can about your cancer, such as its stage (a way of describing a cancer, such as where it is located and if it has spread to other parts of the body). The Cancer.Net Guides to Cancer are a good place to begin. If you are unfamiliar with certain words, ask your doctor or nurse or use a medical dictionary. Some people find it helpful to take notes during a doctor’s visit or bring a friend along to help keep track of all the information.

Know your options. Talk with your doctor about treatment options for your type and stage of cancer. Some of these options may include surgery, radiation therapy, chemotherapy, hormone therapy, active surveillance (watchful waiting), enrolling in a clinical trial, and not receiving treatment. People are often surprised to learn that they may have different treatment options.

Understand the goals of treatment. Often, cancer can be cured with treatment, called curative treatment. However, there are times when treatment is only used to relieve side effects, such as pain, and this is called palliative treatment. Knowing the goals of treatment helps people evaluate which risks are acceptable. For example, people who know their treatment is curative may be more willing to face potentially unpleasant side effects.

Learn about the risks and benefits of each treatment option. Different treatments have different risks, as well as potential side effects. An important part of making a decision is weighing the positives and negatives of each treatment option, including your ability to manage the side effects that are more common for the specific type of treatment. Factors to consider include the likelihood that the cancer will recur (come back) after treatment, the chances of living longer with or without treatment, the possibility of side effects, and your personal and family preferences.

Obtain a second opinion. Many people find that it helps to get a second or even third opinion from another oncologist and many doctors encourage it. Different oncologists may have different experiences with various treatments, and seeking multiple opinions may help you make a decision. Read more about types of oncologists. Also, learn more about seeking a second opinion.

Consult guidelines or other decision-making tools. Many cancer organizations, such as the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN), publish guidelines and treatment decision-making tools to help doctors and people with cancer understand various treatment options. One example is a decision aid tool developed by ASCO and Cancer Care Ontario for people with non-small cell lung cancer. Some cancer centers offer sophisticated statistical tools you can use with your doctor to help determine the best treatment option based on your personal medical information. Always use treatment guidelines and other programs with the help and interpretation of your doctor. Learn more about ASCO’s Patient Guides.

Talk about your decision with people you trust. Talk to your family, friends, a member of the clergy or spiritual advisor, an oncology social worker, and other people with cancer. What you decide is ultimately up to you, but some people find it helpful to talk through their concerns with other people. Many patient support organizations bring together people who have coped with similar experiences.

The role of statistics

Your doctor will probably mention many statistics when describing treatment options, including relative survival rates, disease-free survival rates, and progression-free survival rates. These numbers may be a good way to learn about how the treatment options differ, but they can’t predict how well the treatment will work in an individual. Your doctor can help you understand how these statistics relate to your treatment. Learn more about cancer statistics.

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