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Staging Of Prostate Cancer

The tumour/node/metastasis (TNM) system has become the most widely adopted method for prostate cancer staging.

Stage describes if the tumour was detected or felt during the digital rectal exam

The digital rectal examination gives perceptions of

  • the presence,
  • size,
  • location,
  • degree of local invasion of any given carcinoma

It has been found that approximately 40-60 percent of carcinomas believed to be clinically localized are pathologically non-localized.

Prior to surgery,

  • combinations of clinical stage,
  • serum PSA, and
  • histological grade

these are the most predictive of pathologic stage.

What Is Gleason Score?

  • It is a system of grading prostate cancer.
  • It is based on the appearance of cancer cells under microscope
  • The Gleason Score is very useful for predicting the behaviour of a prostate cancer.
  • used to determine the aggressiveness of prostate cancer
  • can be used to choose appropriate treatment options.
  • Grades 1-5

Gleason scores – range from 2 – 10 , higher number indicating greater risks and higher mortality,


The Management of Prostate Cancer Depends upon

  1. Stage And Grade Of Tumour
  2. Patient’s Age
  3. Co morbid Conditions
  4. Patient Preferences

Most Common Options Are

  1. Surveillance
  2. Waiting
  3. Surgery
  4. Radiation therapy
  5. Focal therapy
  6. Cryotherapy
  7. Hormonal therapy
  8. Chemotherapy
  9. Immunotherapy/vaccine therapy
  10. Bone-targeted therapy
  11. Bisphosphonates
  12. Monoclonal antibody therapy


It is usually recommended in case of

  • early stage prostate cancer (Gleason Score 6)
  • slow growing ,
  • treatment would cause more discomfort than the disease.(Incontinence/erectile Dysfunction)

It is preferred in men with Long Life Expectancy

The cancer is closely monitored for signs of worsening.


  1. A PSA test every 3 to 6 months
  2. A DRE at least once every year
  3. Prostate biopsy
    • within 6 to 12 months,
    • then every 2 to 5 years.

When To Abandon Active Surveillance?

  1. Tests show signs of the cancer becoming more aggressive or spreading,
  2. In case of
  3. Urinary tract Obstruction or blockage.

Are There Any Risks To Active surveillance?

    The main risk of active surveillance is that a slow-growing cancer

  • Sudden  increase  in growth.
  • Cancer that has spread beyond its original site and can no longer be cured.
  • Longer recovery period.
  • Emotional burden of carrying the cancer without it being treated.
  • Benefits of active surveillance

  • No risk of impotence and incontinence associated with treatment.
  • Patient may never require treatment at all.
  • Watchful waiting. 

  • It is an option for old age , when survival is expected to be 5 years or less.
  • Routine tests and examination are not performed.
  • Treatment is recommended if symptoms develop.
  • Quality of Life is an important aspect to be taken into consideration while deciding the treatment options.


  • It is the removal of prostate gland with the tumour in it.
  • Recommended in patients with prostate cancer in whom the cancer has not gone beyond the prostate.
  • Open Radical Prostatectomy
  • Robotic Prostatectomy
  • Nerve sparing surgeries have reduced the incidence of complications, mainly incontinence/ erectile dysfunction.

    Who Will Do The Surgery?

    It is the Urologist or the Urology Oncologist who is responsible for the procedure.

    Which Surgery Has Better Results?

    In terms of

    • Cancer control
    • Complications
    • there are no major differences between the open and robotic procedures.

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