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Article Series: Cancer
Help Me Understand Cancer
What
is Stage-A Prostate Cancer?
Once the diagnosis of prostate cancer has
been made, all subsequent studies and tests are directed at
trying to determine whether the cancer has metastasized. When
cancer cells are shed from the primary tumor site, it is common
for some of them to find their way to the neighboring lymph
nodes, which are part of the immune system that attempts to
fight the spread of the abnormal cells. For this reason, a
number of the lymph nodes in the pelvis are removed and examined
to help determine the extent of the cancer.
Since prostate cancer typically spreads to the skeletal bones
(particularly the hip and lower back), patients diagnosed with
prostate cancer usually undergo bone scans and other tests
that look for signs of cancer in the bones. If the lymph nodes
are negative and there are no cancerous abnormalities detected
in the bones, then it is possible to eliminate the cancer with
localized treatment - either surgery or radiation therapy.
This means the patient has a good chance of being cured of
cancer.
Once a patient has had the diagnosis of prostate cancer established
with a pathological level of differentiation, he will next
engage in a series of evaluations that have an equally important
impact - the determination of the extent of the cancer. Perhaps
the most important information of all to obtain, this determines
whether the patient will be cured of prostate cancer, or whether
he will eventually die from it.
The extent of the cancer - the degree of its advancement -
is called its stage. There are several staging systems for
describing the state of advancement of prostate cancer. It
subdivides the level of advancement into stages A, B, C, and
D, with stage A representing the least advanced disease and
D the most advanced. The first three stages are distinguished
from one another by the size of the tumors.
Stage A
Stage A cancers are microscopic. These cancers
can be divided into two subclasses. Stage A1 cancers are "focal" -
confined to one small area of the prostate - and are composed
of relatively well-differentiated cancer. There are some obviously
cancerous abnormalities in the cells (such as an enlarged cell
nucleus) seen under the pathologist's microscope, but the tumor
cells are of uniform size and closely packed, like healthy
gland cells.
Stage A2 cancers are more diffuse or disseminated (found in
more of the tissue examined), consist of moderately to poorly
differentiated tissue, or display both characteristics. Multiple
tumor sites in the prostate gland or poor differentiation implies
that the cancer is likely to behave aggressively - growing
rapidly or shedding cancerous cells into the bloodstream.
A stage A1 cancer is one picked up incidentally
at the time of transurethral resection of the prostate (TURP)
for apparently
benign enlargement of the prostate gland (BPH), When the "chips" of
removed tissue are examined by the pathologist, microscopic
amounts of cancer, usually well differentiated, are seen. The
transurethral resection was generally all the treatment that
was called for, and more often than not the patient did not
suffer further from the cancer.
With longer term follow-up often to fifteen years, we now
know that about 15 percent of these stage A1 patients show
some form of progressive disease, with about 8 percent of the
patients dying of prostate cancer. Because this type of long-term
follow-up data is available, today patients can be in a better
position to determine whether they want further treatment if
a stage A1 cancer is detected. Currently, we do not have the
same type of long-term follow-up or outcome studies for cancers
detected by PSA-based screening.
Patients with stage A2 disease generally have more cancer
in the gland, with a higher Gleason score. In a proportion
of patients, these cancers may have spread to the lymph node
areas. Thus most if not all A2 patients will end up with some
form of treatment. # # # # #
SolveYourProblem.com
: 2006
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