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What is Stage-A Prostate Cancer?
   

Once the diagnosis of prostate cancer has been made, all subsequent studies and tests are directed at trying to determine whether the cancer has metastasized. When cancer cells are shed from the primary tumor site, it is common for some of them to find their way to the neighboring lymph nodes, which are part of the immune system that attempts to fight the spread of the abnormal cells. For this reason, a number of the lymph nodes in the pelvis are removed and examined to help determine the extent of the cancer.

Since prostate cancer typically spreads to the skeletal bones (particularly the hip and lower back), patients diagnosed with prostate cancer usually undergo bone scans and other tests that look for signs of cancer in the bones. If the lymph nodes are negative and there are no cancerous abnormalities detected in the bones, then it is possible to eliminate the cancer with localized treatment - either surgery or radiation therapy. This means the patient has a good chance of being cured of cancer.

Once a patient has had the diagnosis of prostate cancer established with a pathological level of differentiation, he will next engage in a series of evaluations that have an equally important impact - the determination of the extent of the cancer. Perhaps the most important information of all to obtain, this determines whether the patient will be cured of prostate cancer, or whether he will eventually die from it.

The extent of the cancer - the degree of its advancement - is called its stage. There are several staging systems for describing the state of advancement of prostate cancer. It subdivides the level of advancement into stages A, B, C, and D, with stage A representing the least advanced disease and D the most advanced. The first three stages are distinguished from one another by the size of the tumors.

Stage A

Stage A cancers are microscopic. These cancers can be divided into two subclasses. Stage A1 cancers are "focal" - confined to one small area of the prostate - and are composed of relatively well-differentiated cancer. There are some obviously cancerous abnormalities in the cells (such as an enlarged cell nucleus) seen under the pathologist's microscope, but the tumor cells are of uniform size and closely packed, like healthy gland cells.

Stage A2 cancers are more diffuse or disseminated (found in more of the tissue examined), consist of moderately to poorly differentiated tissue, or display both characteristics. Multiple tumor sites in the prostate gland or poor differentiation implies that the cancer is likely to behave aggressively - growing rapidly or shedding cancerous cells into the bloodstream.

A stage A1 cancer is one picked up incidentally at the time of transurethral resection of the prostate (TURP) for apparently benign enlargement of the prostate gland (BPH), When the "chips" of removed tissue are examined by the pathologist, microscopic amounts of cancer, usually well differentiated, are seen. The transurethral resection was generally all the treatment that was called for, and more often than not the patient did not suffer further from the cancer.

With longer term follow-up often to fifteen years, we now know that about 15 percent of these stage A1 patients show some form of progressive disease, with about 8 percent of the patients dying of prostate cancer. Because this type of long-term follow-up data is available, today patients can be in a better position to determine whether they want further treatment if a stage A1 cancer is detected. Currently, we do not have the same type of long-term follow-up or outcome studies for cancers detected by PSA-based screening.

Patients with stage A2 disease generally have more cancer in the gland, with a higher Gleason score. In a proportion of patients, these cancers may have spread to the lymph node areas. Thus most if not all A2 patients will end up with some form of treatment.

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