Table of ContentsView AllTable of ContentsProstate Cancer StagingRisk GroupsRisk Assessment ToolsPre-Diagnosis Prediction ToolsMaking Treatment DecisionsNext in Prostate Cancer GuideTypes of Prostate Cancer
Table of ContentsView All
View All
Table of Contents
Prostate Cancer Staging
Risk Groups
Risk Assessment Tools
Pre-Diagnosis Prediction Tools
Making Treatment Decisions
Next in Prostate Cancer Guide
Prostate canceraffected close to 200,000 people in 2020. Fortunately, the prognosis of prostate cancer is usually positive because it typically grows and spreads slowly.
Only a small portion of cases turn out to be fatal. In fact, the 5-year-relative survival rate of prostate cancer is 97.8%.
Prostate cancer is staged like most other solid tumor cancers. But, additional risk assessment tools are also used to help direct treatment, including whether surgery is needed.
This article explains what tools are used to stage cancer and assess risk, and how they are used to help make treatment decisions.
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Healthcare providersstage cancerto determine how much cancer is within the body and if it has spread.This can help a person with cancer determine the best course of treatment and understand their chances of survival.
Several tests and procedures are used to stage prostate cancer after a diagnosis is confirmed.
PSA Blood Test
APSA blood testlooks for increased levels of prostate-specific antigens (PSA) in the blood. When the test is used in those who have already been diagnosed with prostate cancer, it can help determine the stage of their cancer.
By combining elevated PSA levels with a physical exam and biopsy results, a healthcare provider can determine how much prostate cancer is in the body and whether or not it has spread to other parts of the body.
Biopsy
In this procedure, the healthcare provider inserts a long, thin, and hollow needle through the rectum or the skin between the anus and the scrotum to gather up to 12 samples. This is performed using ultrasound and/or MRI guidance.
Gleason Score
TheGleason systemassigns tumor grades based on how much the cancer looks like normal prostate tissue. The grades run from 1 to 5 (most normal to least normal). Almost all cases of prostate cancer are grade 3 or higher.
Since prostate cancers often have areas with different grades, a grade is assigned to the two areas that make up most of the cancer. Then, these two grades are added to yield the Gleason score, which can be between 2 and 10.
Based on the score, prostate cancer is classified into three groups:
However, the Gleason score may not always be the best way to describe the grade of cancer. That’s because prostate cancer outcomes can be divided into more than just three groups, and the scale of the Gleason score can be misleading.
Experts developed grade groups to help bridge the gaps. They range from 1 (most likely to grow and spread slowly) to 5 (most likely to grow and spread quickly). Grade Groups correspond to different Gleason scores:
RecapHealthcare providers categorize prostate cancer into stages. Staging helps determine how much cancer is in the prostate and if it has spread. Doctors rely on a PSA blood test, a biopsy, and Gleason score to determine the stage of prostate cancer.
Recap
Healthcare providers categorize prostate cancer into stages. Staging helps determine how much cancer is in the prostate and if it has spread. Doctors rely on a PSA blood test, a biopsy, and Gleason score to determine the stage of prostate cancer.
Types of Prostate Cancer
In people newly diagnosed with prostate cancer, healthcare providers will assess each case individually to determine how aggressive the tumor will likely be and the appropriate course oftreatment.
The National Comprehensive Cancer Network (NCCN) developed guidelines to categorize prostate cancer into risk groups. They take into account blood test and exam results, genetic testing results, and family history to help determine the appropriate risk group:
Prostate Cancer Survival Rates and Statistics
In addition to the NCCN guidelines, healthcare providers also use different risk assessment tools to aid clinical decision-making.
D’Amico Classification
The D’Amico classification was developed in 1998. It uses the following to estimate the risk of recurrence of prostate cancer:
Since it doesn’t take multiple risk factors into account, it may be less accurate in those with more than one risk factor.
Nomograms
Five prostate cancer nomograms can be used to assess risk and predict treatment outcomes. These are based on a person’s specific disease characteristics:
USCF-CAPRA Score
The Cancer of the Prostate Risk Assessment (UCSF-CAPRA) estimates prostate cancer risk based on:
Each factor is assigned a score and then added up to calculate a final risk score. Thus, lower scores equal lower risks and vice versa.
Prostate screening is a personal decision that each individual must make for themselves. However, the American Urological Association (AUA) offers the following guidelines:Recommends against routine screening for people under 40Does not recommend routine screening for people 40-54 at average riskShared decision-making between a person and their healthcare provider when they are between the ages of 55 and 69Does not recommend routine screening for people over 70 or those with a life expectancy of less than 10-15 years
Prostate screening is a personal decision that each individual must make for themselves. However, the American Urological Association (AUA) offers the following guidelines:
Genomic and Proteomic Tests
Genomic and proteomic tests can be used to better understand the possibility of cancer growth or spread. They look at both genes and proteins that are active inside prostate cancer cells to determine the risk. Some tests that are used include the Oncotype DX, Prolaris, ProMark, and Decipher.
RecapRisk assessment tools can help healthcare providers determine how your cancer might behave after treatment based on certain factors, like your age at diagnosis and your results from staging and screening tests.
Risk assessment tools can help healthcare providers determine how your cancer might behave after treatment based on certain factors, like your age at diagnosis and your results from staging and screening tests.
In addition to risk assessment tools used to direct cancer treatment, there are also tools used to predict the likelihood that a biopsy will find prostate cancer. These tools help prevent overdiagnosis and unnecessary biopsy procedures.
Prostate Cancer Prevention Trial (PCPT) Risk Calculator
The Prostate Cancer Prevention Trial Risk Calculator was developed to help clinicians decide whether a biopsy is needed. It takes into account many clinical factors, including:
The results of the calculator may not apply to all individuals. Clinicians should only use it for those who:
Prostate Biopsy Collaborative Group (PBCG) Risk Calculator
The Prostate Biopsy Collaborative Group Risk Calculator (PBCG) is similar in nature to the PCPT in that it looks at a variety of factors to determine candidacy for a biopsy. Thus, it can help to reduce unnecessary biopsies. However, this and the PCPT calculators have shown disparities in results across different race groups.
Prostate cancer treatment is approached with such consideration because the 5-year relative survival rate of all stages combined is high at 98%. Therefore, experts consider some treatment options unnecessary for survivability.
Prostate cancer is easily manageable, especially in the early stages. However, before undergoing treatment, you may want to discuss options with your healthcare provider so that you’re not enduring unnecessary procedures.
If you are the type of person who can wait and see, active surveillance or watchful waiting may be a good option before undergoing treatment. It’s also important to consider the type of treatment and how well you can handle it. Radiation therapy may be a good option for those who don’t want to or can’t have surgery.
You should also consider treatment side effects, especially if you are in a low-risk group. Some side effects such as incontinence, impotence, and bowel issues may arise.Knowing how much time you’re willing to spend in treatment or recovery will also help you and your healthcare provider decide which treatment is best for you.
How Prostate Cancer Treatment Affects Longevity
Summary
Prostate cancer has an extremely high survivability rate. That’s why healthcare providers approach screening, diagnosis, and treatment with such care.
Pre-diagnosis prediction tools can help your healthcare provider determine if you are a good candidate for screening tests. After a cancer diagnosis, numerous tests are used to stage cancer and predict your cancer risk. These all aid in narrowing down which treatment options might be best for you.
A Word From Verywell
Deciding on what course of treatment is best for you may be tough. If you are not comfortable with the options presented to you, you can always seek a second opinion. Many professionals will favor one form of treatment over the other. For example, a surgicaloncologistmay push for surgery, whereas a radiation oncologist will likely suggestradiation.
Since choosing what is best for you can be confusing, reaching out and discussing it with your primary care provider can help you sort out all the available options. They know you well and can help you decide on what works best for you.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barsouk A, Padala SA, Vakiti A, et al.Epidemiology, staging and management of prostate cancer.Med Sci (Basel). 2020;8(3):28. doi:10.3390/medsci8030028National Cancer Institute.Cancer staging.American Cancer Society.Tests to diagnose and stage prostate cancer.National Comprehensive Cancer Network Foundation.NCCN guidelines for patients: prostate cancer early stage.Memorial Sloan Kettering Cancer Center.Prostate cancer nomograms.University of California, San Francisco.Prostate cancer risk assessment and the UCSF-CAPRA score.American Urological Association.Early detection of prostate cancer (2018).American Cancer Society.Prostate cancer stages.Ankerst DP, Hoefler J, Bock S, et al.Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer.Urology. 2014;83(6):1362-1368. doi:10.1016/j.urology.2014.02.035Carbunaru S, Nettey OS, Gogana P, et al.A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort.BMC Urol. 2019;19(1):121. doi:10.1186/s12894-019-0553-6American Cancer Society.Survival rates for prostate cancer.American Cancer Society.Considering treatment options for early prostate cancer.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barsouk A, Padala SA, Vakiti A, et al.Epidemiology, staging and management of prostate cancer.Med Sci (Basel). 2020;8(3):28. doi:10.3390/medsci8030028National Cancer Institute.Cancer staging.American Cancer Society.Tests to diagnose and stage prostate cancer.National Comprehensive Cancer Network Foundation.NCCN guidelines for patients: prostate cancer early stage.Memorial Sloan Kettering Cancer Center.Prostate cancer nomograms.University of California, San Francisco.Prostate cancer risk assessment and the UCSF-CAPRA score.American Urological Association.Early detection of prostate cancer (2018).American Cancer Society.Prostate cancer stages.Ankerst DP, Hoefler J, Bock S, et al.Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer.Urology. 2014;83(6):1362-1368. doi:10.1016/j.urology.2014.02.035Carbunaru S, Nettey OS, Gogana P, et al.A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort.BMC Urol. 2019;19(1):121. doi:10.1186/s12894-019-0553-6American Cancer Society.Survival rates for prostate cancer.American Cancer Society.Considering treatment options for early prostate cancer.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Barsouk A, Padala SA, Vakiti A, et al.Epidemiology, staging and management of prostate cancer.Med Sci (Basel). 2020;8(3):28. doi:10.3390/medsci8030028National Cancer Institute.Cancer staging.American Cancer Society.Tests to diagnose and stage prostate cancer.National Comprehensive Cancer Network Foundation.NCCN guidelines for patients: prostate cancer early stage.Memorial Sloan Kettering Cancer Center.Prostate cancer nomograms.University of California, San Francisco.Prostate cancer risk assessment and the UCSF-CAPRA score.American Urological Association.Early detection of prostate cancer (2018).American Cancer Society.Prostate cancer stages.Ankerst DP, Hoefler J, Bock S, et al.Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer.Urology. 2014;83(6):1362-1368. doi:10.1016/j.urology.2014.02.035Carbunaru S, Nettey OS, Gogana P, et al.A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort.BMC Urol. 2019;19(1):121. doi:10.1186/s12894-019-0553-6American Cancer Society.Survival rates for prostate cancer.American Cancer Society.Considering treatment options for early prostate cancer.
Barsouk A, Padala SA, Vakiti A, et al.Epidemiology, staging and management of prostate cancer.Med Sci (Basel). 2020;8(3):28. doi:10.3390/medsci8030028
National Cancer Institute.Cancer staging.
American Cancer Society.Tests to diagnose and stage prostate cancer.
National Comprehensive Cancer Network Foundation.NCCN guidelines for patients: prostate cancer early stage.
Memorial Sloan Kettering Cancer Center.Prostate cancer nomograms.
University of California, San Francisco.Prostate cancer risk assessment and the UCSF-CAPRA score.
American Urological Association.Early detection of prostate cancer (2018).
American Cancer Society.Prostate cancer stages.
Ankerst DP, Hoefler J, Bock S, et al.Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer.Urology. 2014;83(6):1362-1368. doi:10.1016/j.urology.2014.02.035
Carbunaru S, Nettey OS, Gogana P, et al.A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort.BMC Urol. 2019;19(1):121. doi:10.1186/s12894-019-0553-6
American Cancer Society.Survival rates for prostate cancer.
American Cancer Society.Considering treatment options for early prostate cancer.
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What You Need to Know About Prostate CancerWith many prostate treatment options available, which one is the best for you?Types of Prostate Cancer: What You Need to KnowWhat Are the Signs and Symptoms of Prostate Cancer?What Tests Are Done to Diagnose Prostate Cancer?Get Info on the Typical Progression of Prostate Cancer When UntreatedHow Prostate Cancer Treatment Affects Longevity4 Natural Remedies for Prostate Cancer PreventionThe Risks of Taking Testosterone Treatments With Prostate CancerRadiation for Prostate CancerLearn When Can You Can Have Sex Again After Prostate Cancer Treatment
What You Need to Know About Prostate Cancer
With many prostate treatment options available, which one is the best for you?
Types of Prostate Cancer: What You Need to Know
What Are the Signs and Symptoms of Prostate Cancer?
What Tests Are Done to Diagnose Prostate Cancer?
Get Info on the Typical Progression of Prostate Cancer When Untreated
4 Natural Remedies for Prostate Cancer Prevention
The Risks of Taking Testosterone Treatments With Prostate Cancer
Radiation for Prostate Cancer
Learn When Can You Can Have Sex Again After Prostate Cancer Treatment
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