After proven positive biopsy for prostate cancer the next thing is to stage the disease. "Staging" is used to evaluate disease progression (how far the cancer has spread) in each patient and is based on PSA level at the time of diagnosis, Digital Rectal Examination (DRE) and histology result. According to these, three risk groups are formed: low, intermediate and high.
Gleason score or grade on biopsy describes how closely tumor cells resemble normal prostate cells. A grade of 2 means that cells look almost normal and 10 that cells are very abnormal. A higher score means that a more aggressive tumor exists. Staging is completed with a CT scan of abdomen and pelvis and a whole body bone scan. Rarely seminal vesicle biopsy or pelvic lymph node dissection may be required.
Low-risk patients are those possessing all three low-risk features (table 1) and any type of monotherapy (radical prostatectomy, brachytherapy or external beam radiation) will give them the highest cure rate. Intermediate-risk patients are those that have one intermediate risk feature (table 1). Patients with two or more intermediate features are considered high-risk. High-risk patients are also those that possess at least one of the high-risk features. Intermediate and high-risk patients should be treated with a combination of two or three different therapies in order to achieve the highest cure rate.
|Low risk||Intermediate risk||High risk|
|PSA||< 10||10 - 20||> 20|
|Gleason||≤ 6||7||8 - 10|
|Clinical stage||≤ T2a||T2b,c||> T2c
Table 1: Prostate cancer patients risk groups