The final step in evaluating prostate cancer is called staging. The cancer is given a stage, according to how much it has spread, and a grade, according to how much the cancer resembles normal tissue.
Most cancer specialists use the TNM (Tumor, Node, Metastasis) system to define the cancer. T1 and T2 indicate early-stage disease, and T3 and T4 reflect more advanced cancer. The "N" in thesystem indicates whether the cancer has spread to lymph nodes (tiny organs of the immune system located throughout the body), and the "M" indicates whether the cancer has spread to other parts of the body.
A nine-point (2-10) scoring system known as the Gleason Scale is used to grade prostate cancer based on the appearance of cancer cells and their degree of differentiation or maturity. Most early-stage cancers that are confined to the prostate have Gleason scores, or grades, within the range of 4 to 6.
The National Cancer Institute uses this staging system:
Stage A: The cancer cannot be felt and causes no symptoms. The cancer is only in the prostate and is usually found accidentally during surgery for other reasons.
AI: Cancer cells are found in only one area of the prostate.
AII: Cancer cells are found in many areas of the prostate.
Stage B: The tumor can be felt during a rectalexam but the cancer cells are found only in the prostate.
Stage C: Cancer cells have spread outside the surface of the prostate to tissue around the prostate; the glands thatproduce semen may have cancer in them.
Stage D: Cancer cells have spread to lymph nodes or to organs and tissue far away from the prostate.
DI: Cancer cells have spread to lymph nodes near the prostate.
DII: Cancer cells have spread to lymph nodes far away from the prostate or to other parts of the body such as the bone, liver or lungs.
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