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Prostate Cancer Overview

Statistics

Prostate cancer is the most common cancer (not including skin cancer) in men.

About 140,000 new prostate cancers are diagnosed yearly in the U.S.  About 40,000 men die of prostate cancer per year in the U.S.  One in every ten men in the U.S.  will develop prostate cancer.  In other words, the risk of developing prostate cancer in a man's lifetime is 10%.

Risk Factors:

Age: As a man ages, his risk of developing prostate cancer increases.


AGE RISK (%) RISK (RATIO)
40 0.01% 1 In 10,000 Men
50 0.3% 1 In 333 Men
55 1% 1 in 100 Men
60 2.5% 1 In 40 Men
65 5.1% 1 In 19 Men
70 8.5% 1 In 11 Men
75 12.0% 1 In 8 Men
80 14.8% 1 IN 7 Men
85 16.6% 1 In 6 Men
90+ 17.5% 1 In 5 Men

Family history: Having one first degree relative (brother or father) with prostate cancer increases the risk of prostate cancer by two fold.  If a person has more than one first degree relative with prostate cancer, his risk will increase by four to nine folds.

Ethnicity: African Americans have the highest risk of developing prostate cancer, while Asian Americans have the lowest risk.

Hormones: Prolonged exposure to testosterone is believed to be associated with prostate cancer.  Men who lost both testicles before puberty have virtually no chance of developing prostate cancer.

Staging of prostate cancer:

Stage of prostate cancer has to do with how extensively or how far it has grown at the time of diagnosis.  Early stage or "organ confined" indicates a cancer that is still confined to the prostate.  Advanced stage is when the cancer has spread to other areas in the body.  The following is a simplified table of prostate cancer staging:

  1. Stage I: Cancer that cannot be felt during a rectal exam.

It is usually discovered when surgery is done for a benign prostatic process.  Cancer is confined to the prostate and occupies a small amount of the prostate.

  1. Stage II: Cancer more advanced, but still confined to the prostate.
  2. Stage III: Cancer beyond capsule of prostate, possibly in the seminal vesicles.
    1. IIIa: Cancer outside capsule in fatty area or tissue containing nerves
    2. IIIb: Cancer outside capsule invading into the seminal vesicles
  3. Stage IV: Cancer spread (metastasized) to other organs or lymph nodes

A more detailed form of staging is TNM prostate cancer staging.  The TNM Staging System describes the extent of the primary tumor (T), the absence or presence of metastasis to nearby lymph nodes or glands (N), and the absence or presence of distant metastasis (M)

Tumor (T) Status

  1. Stage T1: Not Palpable by DRE, Confined to prostate
    1. T1a Incidentally found on TURP, less than 5% of tissue
    2. T1b Incidentally found on TURP, more than 5% of tissue
    3. T1c Found by needle biopsy due to elevated PSA
  2. Stage T2: Confined to prostate on DRE or Prostatectomy
    1. T2a Tumor involves half of one lobe or less
    2. T2b Tumor involves more than half of one lobe
    3. T2c Tumor involves both lobes
  3. T3 Tumor extends through prostate capsule on DRE or Prostatectomy
    1. T3a Tumor just beyond capsule on one side
    2. T3b Tumor just beyond capsule on both sides
    3. T3c Tumor invades Seminal Vesicle(s)
  4. T4 Tumor extends to adjacent organs (other than Seminal Vesicles)
    1. T4a Tumor invades Bladder/external sphincter/rectum
    2. T4b Tumor invades levator muscles/pelvic side wall

Node (N) Status

  1. N0 No lymph node (LN) metastasis
  2. N1 Tumor in one LN less than 2 cm
  3. N2 Tumor in one LN between 2-5 cm, or multiple LN less than 5 cm
  4. N3 Metastasis one or more LN more than 5 cm

Metastasis (M) Status

  1. M0 No distant metastasis
  2. M1a Distant (non-regional) LN involvement
  3. M1b Metastasis to the bones
  4. M1c Metastasis to other distant organs (lung, brain, liver)

Relationship between TNM Prostate Cancer Staging and Stage categories I to IV:

STAGE T N M
I T1 N0 M0
II T2 N0 M0
III T3 N0 M0
IV T4 N0-N3 M0-M1
IV Any T N1-N3 M1
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