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Understanding the stages

The Stages

Here are the various procedures available to move towards an accurate diagnosis:

The Stages

Understanding the stages

If you’ve been diagnosed with prostate cancer, you’ll need to have further tests to determine if the cancer has spread in the prostate or to other parts of the body. Staging is the term used to refer to the stage of the cancer and indicates the spread of the disease in the body. Staging is also used to plan treatment strategies.

In order to determine the stage of prostate cancer, the results of previous tests will be used (such as your PSA result) as well as results of other procedures, including:

This is used to check for cancer cells in the bone. A small amount of radioactive material is injected into your vein, travels through the bloodstream and collects in any abnormal cells in the bones. A scanner is used to look for collections of radioactive material

This can demonstrate differences between normal and diseased parts of prostate tissue and assess whether cancer infiltrates the capsule of the prostate gland and/or other pelvic tissues outside of the prostate gland. An MRI scan also looks for lymph node involvement. It is the preferred diagnostic tool. 

This gives an assessment of the prostate gland position, its appearance and its relationship to other pelvic organs. It also helps plan radiation therapy. A CT scan is used no if there is no access to an MRI or if doing an MRI scan is too expensive. 

This is a surgical procedure to remove the lymph node of the pelvis. Cells are then taken from the lymph node and viewed by a pathologist under a microscope to look for cancer cells.

A needle is used to remove fluid from the seminal vesicle, which makes semen. The fluid is viewed by a pathologist under a microscope to look for the presence of cancer cells.

PET Scan: Positron emission tomography (PET) scan is an imaging test that can help reveal the metabolic or biochemical function of your tissues and organs. The PET scan uses a radioactive drug (tracer) to show both normal and abnormal metabolic activity.

PSMA Scan: Prostate Specific Membrane Antigen (PSMA) imaging is a novel imaging modality, which is now commonly used in detecting prostate cancer. It makes use of a radioactive imaging molecule, which binds to prostate cancer cells, to help locate if, and where, the prostate cancer has spread, throughout the body. This type of imaging, is done, by a specialist Nuclear Physician.

The most widely used staging system for prostate cancer is the American Joint Committee on Cancer (AJCC) TNM system.

The TNM system for prostate cancer is based on 5 key pieces of information:

  1. The extent of the primary tumour (T1 to T4 category)
  2. Whether the cancer has spread to nearby lymph nodes (N0 to N1 category)
  3. The absence or presence of distant metastasis (M0 to M1 category)
  4. The PSA level at the time of diagnosis
  5. The Gleason score
  1. Cansa.org. Fact Sheet on Prostate Cancer. https://cansa.org.za/files/2021/04/Fact-Sheet-on-Prostate-Cancer-NCR-2017-web-March-2021.pdf. Accessed on 22 October 2021.
  2. National Cancer Institute. Stages of Prostate Cancer. https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#_120. Accessed on 22 October 2021.
  3. American Cancer Society. Initial Treatment of Prostate Cancer, by Stage and Risk Group. https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html. Accessed on 22 October 2021.
  4. American Cancer Society. Prostate Cancer Stages. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html. Accessed on 22 October 2021.

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