Metastatic or stage 4 prostate cancer is cancer that has spread from the prostate to other organs of the body. Even though it has spread to other parts of the body the cancer is still known as prostate cancer.
Prostate cancer most commonly spreads to the bones, liver, lungs, and lymph nodes.
Prostate cancer stages and grades
In order for your medical team to make an accurate diagnosis and a more effective treatment plan the severity and progression of your prostate cancer will be categorised by stages and grades.
It’s important to note that different stages and grades of prostate cancer can affect treatment options and prognosis, but early detection and treatment can improve outcomes.
Stages of prostate cancer
Your doctor will use the TNM system along with the ISUP or Gleason Score to determine the stage of your cancer.
T - relates to the primary tumour, its size, and where it is located.
N - identifies if the cancer has progressed into the lymph nodes, if it has how, where and how many?
M - explains if the cancer has spread beyond the prostate into other parts of the body
The different stages specify the size of tumours and if cancer cells have spread to other areas of your body.
Early Stage Prostate Cancer
- Stage I: The cancer cells are confined to the prostate
- Stage II (may be divided into IIA or IIB or IIC): The cancer is still localised to the prostate but appears more likely to spread.
Locally Advanced
- Stage III (may be divided in IIIA IIIb IIIC): The cancer has spread outside of the prostate and into nearby organs or tissues.
Metastatic:
- Stage IV (maybe be divided into stage IVA or IVB): The cancer has spread to more distant sites.
Depending on its site of metastasis the cancer can be classified as either:
- Prostate cancer stage IVA: The cancer has spread to lymph nodes nearby
- Ovarian cancer stage IVB: The cancer has spread to other organs or more distant lymph nodes.
Grades of prostate cancer
Traditionally the Gleason Score grading system has been used to evaluate how aggressive prostate cancer cells appear under a microscope. It helps your medical team understand how likely or quickly the cancer is to spread or grow.
Gleason Scores range from 6 to 10, with higher scores indicating more aggressive cancer:
- Gleason X: Cancer Undetermined
- Gleason 6: Low Grade, the cancer cells closely resemble normal prostate cells and are less aggressive.
- Gleason 7: Moderately differentiated from normal prostate cells but with some more aggressive features.
- Gleason 8: Less resemblance to normal prostate cells with more aggressive features.
- Gleason 9: Very different to normal prostate cells and highly aggressive.
- Gleason 10: Little resemblance to normal prostate cells and extremely aggressive.
A newer classification system has been introduced that makes grading prostate cancer simpler and easier to understand. The new system is called the International Society of Urological Pathologists (ISUP) Grade Group System. This system grades prostate cancer between 1-5 (the higher the score the more aggressive the cancer)
ISUP Grades:
- ISUP 1: Cancer cells are slow growing and less likely to spread and therefor low risk’
- ISUP 2: The Cancer cells are moderately likely to spread but less aggressive (favourable)
- ISUP 3: The cancer cells are moderately likely to spread but are more aggressive (unfavourable)
- ISUP 4: The cancer cells are more likely to spread and are fast growing
- ISUP 5: The cancer cells are most likely to spread and are fast growing
Who will be part of my metastatic prostate cancer medical team?
Depending on your diagnosis and treatment plan your Metastatic Ovarian Cancer care team may include:
- Urologist: doctors who specialise in diseases and conditions of the urinary tract and male reproductive system. They may be involved in initial diagnosis, treatment decisions, and monitoring of prostate cancer.
- Urological Oncologist: A specialist in cancers that affect the urinary tract and the male reproductive system. They will undertake any surgery required and be involved in the medical management of your prostate cancer.
- Medical Oncologist: Specialises in cancer drug therapies such as; chemotherapy, targeted therapy, hormone therapy and immunotherapy. They develop and oversee your medical treatment plan.
- Radiation oncologist: Will be involved if radiation is deemed necessary to target specific areas affected by cancer. These doctors specialise in using radiation therapy to treat cancer.
- Clinical nurse specialist: have specialised skills, knowledge and experience in caring for patients with a diagnosis of urological cancer. They provide the continuing link throughout your care and support you and your family with your cancer journey
- Pathologist: Collects and examines tissues and blood samples to diagnose cancer and determine its characteristics. Their findings help guide treatment decisions.
- Radiologist: A doctor who interprets medical imaging (such as CT, MRI, ultrasound & PET scans) to help diagnose and monitor the progression of cancer.
- Radiographer: Specialises in performing ultrasounds, x-rays, CT, MRI’s and a variety of other necessary scans.
- Oncology nurse: Nurses who specialise in cancer care and provide support, administer treatment and monitor patients.
- Chemotherapy nurse: Specialises in administering chemotherapy drugs and provides support throughout the treatment.
- Palliative care specialist: A doctor who focuses on managing symptoms, pain and improving quality of life of patients with cancer, they often work alongside the primary oncology team.
- Palliative care clinical nurse: provide symptom management for patients, support physical, psychological and spiritual needs and educate patients and families about the dying process.
- Social worker: Offers emotional support, helps patients navigate the healthcare system, and provides resources for coping with the challenges of cancer.
Additional team members
Not all patients will require every health care practitioner to be part of their team; depending on your diagnosis and current treatment plan, your care team may also include:
- Genetic counsellor: A specialist that may be recommended for you if you have a strong history of ovarian cancer in your family or test positive for a gene mutation.
- Exercise physiologist: Specialises in prescribing exercise plans to improve a patient’s quality of life, strength, overall health, and energy levels.
- Nutritionist/dietician: Provide advice regarding nutrition during and post-treatment, which can help to alleviate discomfort with treatment side effects.
- Lymphoedema practitioner/physiotherapist: Educates patients about the prevention and management of lymphoedema and may offer treatments to help.
- Psychologist/psychiatrist or counsellor: Mental health professionals who support patients with managing the emotional and psychological responses to cancer diagnosis and treatment.
