Facts on File Encyclopedia of Health and Medicine

to further classify and understand the prostate
cancer’s characteristics to optimally tailor treat-
ment approaches. The two main conventional
staging systems are

• the numeric system, which identifies five levels
  of tumor aggressiveness (stage 0 through stage
  4, or IV)


• the American Joint Committee on Cancer
  (AJCC) tumor, node, and metastasis (TNM) sys-
  tem, which assigns numeric values to the size

of the tumor, invasion of LY M P H nodes, and

spread to distant organs or structures

Treatment Options and Outlook

The treatment of choice for men under age 70 is

nearly always PROSTATECTOMY, a surgical OPERATION

to remove the prostate gland, with adjuvant (fol-

low-up) CHEMOTHERAPY, RADIATION THERAPY, or HOR-

MONE THERAPYas appropriate. Radiation therapy is

most effective when the cancer remains confined

to the prostate gland. For men over age 70, in

prostate cancer 329

GLEASON PATTERNS AND SCORES FOR PROSTATE CANCER

Gleason Pattern
pattern 1 cells and architecture nearly normal (well differentiated)
pattern 2 cells nearly normal though glandular cells beginning to invade MUSCLEtissue within thePROSTATE GLAND
pattern 3 cells still maintain glandular structure though invasion of muscle tissue within the prostate gland is significant;
possible regional METASTASIS
pattern 4 significant cell abnormality with loss of normal architecture and distorted glandular structure; probable regional
metastasis; possible distant metastasis
pattern 5 cells and architecture completely irregular and abnormal (undifferentiated); probable distant and multiple
metastases

Gleason Score
2 lowest possible score; very early cancer with excellent prognosis
3 to 4 slow growing tumor; early cancer with good prognosis
5 to 6 mildly aggressive tumor likely confined to the prostate gland
7 moderately aggressive tumor with possible regional metastasis
8 to 9 aggressive tumor with regional metastasis
10 highly aggressive tumor with multiple distant metastases

JEWETT STAGING SYSTEM CLASSIFICATIONS

stage A very early, localized cancer; only indication is elevated BLOOD PROSTATE-SPECIFIC ANTIGEN(PSA) level
A1: well-differentiated or single site within PROSTATE GLAND
A2: clearly abnormal cells or multiple sites within prostate gland
stage B localized cancer palpable via DIGITAL RECTAL EXAMINATION(DRE); may cause mild symptoms
B1: single site
B2: multiple sites
stage C METASTASISto adjacent tissue but not to LYMPHnodes
C1: tumor is outside the prostate gland but nonobstructive
C2: tumor obstructs the BLADDERor the URETHRA(urinary symptoms)
stage D metastasis to lymph nodes or distant organs
D1: regional LYMPH NODEinvolvement
D2: distant lymph node or organ involvement (including BONE)
D3: RECURRENCEafter treatment