Stage 2 (II) Prostate Cancer

Summary: A diagnosis of stage 2 prostate cancer means that cancer cells are localized to the prostate gland and have not spread (metastasized) to other areas of the body. Stage 2 prostate cancer survival rates are high.

Introduction - What Is Stage 2 Prostate Cancer?

Prostate cancer, the most common form of cancer found in men, originates in the prostate gland. Found underneath the bladder, this gland creates part of the seminal fluid.

When prostate cancer develops, cancerous cells in the prostate gland can multiply, invade surrounding healthy tissue, and form tumors. Where prostate cancer cells are invasive, the cancer can be described as being malignant. If prostate cancer is left undiagnosed and untreated, there is a greater likelihood that this disease will spread to other parts of the body lowering overall chances of survival.

Physicians 'classify' or 'stage' prostate cancer to determine how developed and widespread it has become. The prostate gland can be divided into distinct areas known as 'lobes' or 'zones'. The degree to which these lobes have been affected help determine the stage of prostate cancer. Once prostate cancer has been staged, an appropriate course of treatment and more accurate prognosis can be given.

A diagnosis of stage 2 prostate cancer means that this disease has progressed to the second out of four possible stages. At stage 2, cancer cells within the prostate are in greater numbers compared to stage 1, but are still localized to the prostate.

As stage 2 prostate cancer is still localized to the prostate gland, it is often regarded as being at an early stage. Stage 2 prostate cancer has two sub-stages, 2a and 2b, which are distinguished by the number of cells and parts of the prostate affected.

Better prognosis and survival rates are associated with stage 2 (and stage 1) prostate cancer.

Diagnosing Stage 2 Prostate Cancer

A stage 2 prostate cancer diagnosis can only be made after a number of tests have been given. Such tests may include:

A Needle Biopsy (seminal vesicle biopsy): a needle is inserted into the seminal vesicles, which are glands connected to the prostate, and a sample of fluid is taken. This sample is then analyzed using a microscope. If a certain level of cancerous cells are found and the cancer is still localized to the prostate, a diagnosis of second stage prostate cancer may be made.

Imaging Tests: MRI or CT (CAT) scans determine whether tumors (lumps formed from cancerous cells) are present and the cancer has spread.

Digital Rectal Examination: a finger is inserted in the rectum to feel for any abnormalities of the prostate area.

PSA Test: prostate-specific antigen (PSA) is a protein created in the prostate gland and found in the blood. Higher levels of PSA may indicate prostate cancer (or other conditions of the prostate such as inflammation).

Gleason Test: the Gleason grading system assesses how aggressive a cancer is. The arrangement of cancer cells are examined underneath a microscope and patterns of cells are graded.

After the relevant tests have been taken, prostate cancer can be staged using a four stage system.

Currently, there are two main systems used to stage prostate cancer. The TNM system uses four categories 1-4 and the Whitmore-Jewett system uses four categories: A-D.

Diagnosis With The TNM System

When using the TNM System, a patient's PSA and Gleason scores are usually considered. Using the TNM system Stage 2 prostate cancer can be:

Stage 2a: prostate cancer cells are confined to one lobe, the PSA is less than 10 and the Gleason score 6 or less.

Stage 2b: prostate cancer cells are found in both lobes, or, cancer cells are found in one lobe and the PSA score is equal to or greater than 20, or, the Gleason score is equal to or greater than 8.
(Reference: AJCC Cancer Staging Manual, 7th Edition)

The main difference between the Stage 1 grade and Stage 2a grade is that at Stage 2a the PSA and/or Gleason score is higher. Whilst there are there are typically more prostate cancer cells at stage 2, they are still confined to the prostate gland and have not spread.

Diagnosis With The Whitmore-Jewett System

The Whitmore-Jewett System is an older system. It differs from the TNM system in that the stage and sub-stage is determined by whether the tumor can be felt by a physical examination* and by the PSA score.
*a digital rectal examination

  • Stage B () - a tumor is not detected but PSA levels are very high.
  • Stage B1 - a tumor can be felt. It is confined to one lobe.
  • Stage B2 - a tumor can be felt. It is found in both lobes.

The TNM system when used in conjunction with PSA and Gleason scores is generally favored over the Whitmore-Jewett system; it is thought to give a more accurate diagnosis.

Stage 2 Prostate Cancer Symptoms

Symptoms for stage 2 prostate cancer often center around sexual and urinary problems. Each case is different, and people diagnosed with stage 2 prostate cancer may not experience all of these symptoms.

Sexual Problems

  • Impotence - a man may have difficulty having an erection or maintaining an erection.
  • Hematospermia - a condition in which there is blood in the semen.
  • Painful ejaculations

Urinary Symptoms

  • Problems starting urination
  • Weaker flow when urinating
  • Pain when urinating - a burning sensation may be experienced
  • Blood in the urine
  • Frequent urination

See also, 'Symptoms Of Prostate Cancer'.

Stage 2 Prostate Cancer Treatment

The course of treatment for Stage 2 prostate cancer is determined on a case by case basis. Often, the Gleason and PSA scores are considered along with the age of the patient and their general life expectancy.

In some cases, the cancer may not be appear to be very aggressive, and the benefits from a 'watch and wait' approach may be higher than the outcome from medical treatment (particularly where the patient is of an advancing age).

When medical treatment is given, one, or a combination, of three main types of treatment may be chosen.

1. Radical Prostatectomy - this is the term for a surgical procedure in which the prostate gland and connected seminal vesicles are removed from the patient. This procedure carries its own complications. Surrounding nerves can be damaged when the prostate gland is removed and sexual dysfunction problems may arise. Removing the prostate gland will only 'cure' prostate cancer if no cancer cells have spread to other areas. If the patient is in their advanced years the prostate gland may be left in place.

2. Radiation Therapy - this is a well established treatment for prostate cancer and many other cancers. Radiation is used to kill cancer cells and shrink tumors.

3. Hormone Therapy - androgen deprivation therapy (ADT) suppresses the level of the male hormone androgen, which can either slow down the rate of tumor growth or shrink them.

Stage 2 Prostate Cancer Prognosis & Survival Rates

Prognosis refers to the outcome of a disease or condition. A stage 2 prostate cancer prognosis usually centers around the survivability of a patient.

Survival rates are often expressed as a percentage chance of surviving a certain period of time since diagnosis (usually 5 or 10 years).

Whilst each case is different, overall, the prognosis for stage 2 prostate cancer is good.

The stage 2 prostate cancer survival rate is high with nearly 100% surviving at least 5 years after initial diagnosis.