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Understanding Localized Cancer

Early stage, or localized, prostate cancer refers to cancer that is still confined to the prostate, either Stage I or Stage II. Early stage prostate cancer may be easier to cure and treatment is done with the aim to cure the cancer. If you have been diagnosed with a later stage (III or IV) or advanced prostate cancer, visit our Advanced Prostate Cancer section to learn more.

Now that you’ve had a biopsy and possibly other tests to confirm you have prostate cancer, you will learn more about the characteristics of your cancer. The following tests will help to provide more information about the cancer to help your doctor make the best treatment recommendation for you. Learn more about grading and staging.

PSA Level

A Prostate Specific Antigen (PSA) test measures the level of PSA, a biological marker, in the blood. PSA is a substance made by the prostate and is sometimes higher in men who have prostate cancer at the time of their diagnosis.

Gleason Score/ Cancer Grade

The Gleason Score or grade of the cancer indicates how aggressive the tumor is, and may predict how likely it is to grow or spread. This is a description of the tumor based on how abnormal the tumor cells and tissue look under the microscope. The Gleason score refers to how different the prostate cancer cells appear in comparison to normal prostate cells and are assigned a score. Today almost all men with prostate cancer have a Gleason Score of between 6 and 10, a number that is generated by adding the two most common patterns seen within the tumor.

Digital Rectal Examination

A digital rectal examination (DRE) is performed by the physician to determine if there are any abnormalities on the surface of the prostate. It is performed inserting a gloved, lubricated finger into the rectum. While some men may feel uncomfortable with this examination, it is rarely painful and can give the physician important information about the stage of the cancer.

Risk Group

For men who have been diagnosed with early stage, also called localized, prostate cancer, there are four types or risk categories. These risk categories relate to the chance of the cancer coming back after treatment or quickly progressing. Early stage prostate cancer is found only in the prostate gland and has not spread beyond the prostate to nearby tissue or to another part of the body. This risk group is determined by a combination of the PSA level, Gleason score, and DRE results.

  • Very-low-risk prostate cancers are unlikely to grow for many years
  • Low-risk prostate cancer are unlikely to grow or spread for many years
  • Medium (intermediate) risk prostate cancer are unlikely to grow or spread for a few years
  • High-risk prostate cancer may grow or spread within a few years

Stage

The stage tells you the location and how large (in relation to the prostate) the tumor is. Early stage prostate cancer is found only in the prostate. Stage I or Stage T1 means the cancer is small, may be too small to feel by the doctor and only in the prostate. Stage II or Stage T2 means the cancer is larger, only in the prostate and is large enough to be felt by the doctor.

These and other factors help your physician determine the stage of your prostate cancer and the risk group: low, medium/intermediate or, high risk. In fact it is believed that in more than half of men newly diagnosed with low-risk prostate cancer the cancer will not spread to other parts of the body.

Genomic Testing

Fortunately there are several new, genomic tests available today that allow us to go beyond the standard risk assessment done with the PSA, the Gleason Score and the DRE. These tests may be helpful when making a treatment choice if you have low risk prostate cancer because you might be a good candidate for Active Surveillance (AS). AS is a way of closely monitoring your cancer that may allow you to avoid treatment, if possible, or to give treatment if the cancer progresses while it is stil localized, if necessary. If you have high risk prostate cancer, most likely your doctor will suggest an aggressive course of treatment because you are at high risk for the disease to spread throughout your body.

These genomic tests look at the genetic markers of the cancer cells to tell us how the cancer may behave. This allows the physician to provide a more personalized risk assessment when suggesting treatment options.

These tests look at the activity of certain genes in the tumor to predict how likely it is that the prostate cancer will grow and spread. When making a treatment decision, having more information about how the cancer will behave can help you have more confidence in your treatment decision. Visit our genomic testing section to learn more about these tests.

Tests

  • Oncotype Dx
    • This test looks at the activity of certain genes in the prostate tumor. It then determines if men with low-risk prostate cancer are good candidates for watchful waiting/active surveillance or if their disease will be more aggressive and spread to other parts of the body if left untreated. A personalized result, called the Genomic Prostate Score, is assigned and this number predicts the chance of the prostate cancer growing and spreading.
  • Prolaris Test 
    • The Prolaris test measures how fast your cancer cells are dividing to predict aggressiveness. It predicts both biochemical recurrence and the potential for spread of the disease.

Hear our experts discuss diagnosing prostate cancer.

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