Staging | Prostate carcinoma

Staging

Once the grading and staging has been completed and the PSA level determined, prostate cancers can be further grouped into different stages with similar prognosis. An often used classification is that according to UICC (Union internationale contre le cancer). Stage I prostate carcinomas are those that are confined to the prostate, have no lymph node involvement or metastases and have a rather low Gleason score (up to 6) and PSA level (below 10 ng/ml). Stage II includes prostate carcinomas that are also restricted to the prostate, have no lymph node involvement or metastases but have a significantly higher Gleason score and PSA value.Stage III is prostate carcinomas that have broken through the organ capsule and stage IV is tumors that have already affected neighboring organs or lymph nodes or have metastasized. The risk of dying from prostate cancer within a few years increases with the stage, but the choice of therapy is also usually based on the stage of the tumor.

Guideline

The Association of the Scientific Medical Societies in Germany (AWMF) is an organization that publishes so-called guidelines for a wide variety of clinical pictures. These guidelines are intended to help treating physicians make decisions regarding the therapy of their patients. The guidelines are based on the current state of research and are intended to ensure greater safety in medicine and for patients.

There is also a current guideline for prostate cancer. In this guideline, a fundamental distinction is made between the first-time occurrence of non-metastatic prostate cancer and recurrence or metastatic prostate cancer. For patients with non-metastatic carcinoma, curative, i.e. curative treatment options are considered.

These include surgery (radical prostatectomy), radiotherapy and active surveillance. Prerequisites for the choice of this therapy option, active surveillance, are a PSA value below 10 ng/ml, a Gleason score below 6 or a tumor stage T1 or T2a. In these patients, the PSA level is checked again every three to six months and a DRU is performed.

In older patients, it is also possible to switch to the therapy concept of long-term observation (watchful waiting). In this case, the course of the disease is only intervened if symptoms occur. The localized prostate carcinoma can still be treated surgically or with radiation therapy.

Both procedures are considered to be approximately equivalent and should be carefully examined in each individual case. For patients with locally advanced, i.e. metastasized, prostate cancer, both surgical and radiation therapy are possible. Here, too, the patient should be informed about both procedures on a case-by-case basis and, taking into account the respective advantages and disadvantages, the decision on further treatment options should be made together with the specialist.

If curative treatment is no longer possible, palliative treatment options are considered according to the guideline. These are, on the one hand, hormone-ablative therapy and watchful waiting, in which only symptom-dependent and palliative intervention is possible. Although hormone ablative therapy extends the time interval without further deterioration, data on overall survival remain unclear. In any case, the patient should be informed about both options.