Stages of cancer
Treatment for cancer depends on the and grade of the cancer. Standard treatment may include a combination of surgery, radiation, and/or hormonal therapies. People with advanced or recurrent cancers may also benefit from chemotherapy, or . Clinical trials may be available for any of cancer.
Grades and stages of cancer
Measuring the grade and of cancer helps doctors decide how to treat it.
The grade of a cancer helps doctors predict how quickly the cancer is likely to grow and spread. Doctors use a scale called the Gleason score to measure and report the grade of cancer. The Gleason score is based on how abnormal the cells appear in the two largest areas of the tumor. The pathologist assigns a score of 1-5 for each area and adds them together for the Gleason score. Although Gleason scores can range from 2-10, most cancers will be scored as 6 or higher. The higher the score, the more abnormal and aggressive the cells appear.
- A score of 6 is low grade.
- A score of 7 is intermediate grade.
- A score of 8 to 10 is high grade.
An updated grading system is now in use. This is call Grade Group and corresponds to Gleason score as follows:
- Grade Group 1: Gleason score <=6
- Grade Group 2: Gleason score = 7 (3+4)
- Grade Group 3: Gleason score = 7 (4+3)
- Grade Group 4: Gleason score = 8
- Grade Group 5: Gleason score = 9-10
The refers to whether the cancer has spread beyond the , and if it has, the location in the body where it has spread. Doctors use the following information to prostate cancer:
- size of the tumor
- whether the cancer has spread to nearby
- the presence or absence of spread beyond the and ()
- levels at the time of diagnosis
- Gleason score
Using this information, cancer is grouped into four stages, with 1 being the least advanced and 4 being the most advanced.
- 1 cancer is contained to the , has a Gleason score of 6 or below and a level of less than 10.
- 2 cancer is more advanced but has not spread beyond the .
- 3 cancer extends beyond the but has not spread to .
- 4 ( prostate cancer) has spread to another part of the body outside of the . Common areas of spread include the bladder, rectum, or bones.
Additional tests for
After grading and , additional tests or imaging may be done to check for cancer spread, though these are not required for all men with newly diagnosed cancer.
Additional tests are run if:
- levels are high
- The Gleason score is high
- The cancer is large
- The cancer has spread to or beyond
The tests may include:
- Computed tomography (CT) scans of the abdomen and pelvis
- Bone scans
- Magnetic resonance imaging () of your pelvis
- Positron emission tomography (PET) scans.
- Pelvic lymph node dissection (PLND)
Additional tests can be performed on tumor samples to help guide treatment. For some patients, tumor testing can help guide the choice of or .
If you have cancer, you can find peer support through the following resources:
- FORCE support:
- Register for the FORCE Message Boards to connect with others who share your situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- FORCE's Peer Navigation Program will match you with a volunteer who shares your mutation and situation and provide you with a free resource guide.
- Contact the FORCE impact leaders in your area to link to local support groups and other resources.
- Attend a virtual support meeting in your area.
- Read the stories from members of our community.
The following are studies looking at new methods for , monitoring and finding recurrence in people with cancer.
- NCT02282137: 68Ga-PSMA PET-CT Scan for Diagnosis and Management of Cancer (PSMA). This study looks at 68Ga-PSMA-11 PET-CT scan works to detect tumor location and size in patients with suspected or confirmed cancer, as well as cancer that may have come back.
- NCT04614363: 68 Ga-PSMA for High Risk Cancer. 68GA-PSMA-11 will be given prior to PET/CT imaging in men with localized high risk cancer or biochemical recurrence to determine if it changes medical management.
- NCT03439033: Comparison of PET/CT or PET/MRI Imaging to Alone in Men With Cancer. This study will compare standard imaging to imaging using an experimental tracer, 68Ga-PSMA-HBED-CC, among men with cancer or prostatic cancer recurrence/metastasis.
- NCT04716725: 68Ga-PSMA-11 PET for the Diagnosis of Castration Resistant Cancer. This trial aims to see whether using 68Ga-PSMA-11 PET scans may help doctors learn more about where disease is located in the body.
- NCT04777071: An Investigational Scan (68Ga-PSMA-11 PET/CT) for the Imaging of Cancer. This trial studies how well 68Ga-PSMA-11 PET/CT scan works in imaging patients with cancer.
- NCT04928820: 68Ga-PSMA-11 PET/CT for the Diagnosis of Bone Metastases in Patients With Cancer and Biochemical Progression During Androgen Deprivation Therapy. This studies how well 68Ga-PSMA-11 PET/CT works in detecting the spread of cancer to the bones in patients with cancer and increased after treatment with .
- NCT03824275: 18F-DCFPyL PET/CT in Men With Cancer. This study will look at a new tracer in detecting in people with cancer.
- NCT03204123. PSMA PET Imaging of Recurrent Cancer. The purpose of this study is to see if a new diagnostic research agent named 68Ga-HBED-CC-PSMA can show cancer on a PET/CT scan that cannot be seen on other standard imaging even when the levels are very low.
A number of other clinical trials for monitoring patients with cancer can be found here.