Stage 3 (III) Prostate Cancer

Prostate cancer is the most common type of cancer found in men. 'Stage 3', is a term used by physicians to classify the extent to which prostate cancer has developed within the body. Stage 3 may be expressed using Roman numerals (Stage III).

If prostate cancer is classed as stage 3, a cancerous tumor in the prostate has extended through the membrane (cover) of this gland. At stage 3, no other areas are affected except for, in some cases, the seminal vesicles (see below).

Stage 3 prostate cancer is known as 'locally advanced'. Whilst the cancer may have extended through the prostate gland and invaded the seminal vesicles, it has not spread to nearby lymph nodes or other areas of the body. Stage 3 is the penultimate stage (last but one). At stage 4, prostate cancer has metastasized, spreading to lymph nodes and other areas of the body.

This article discusses how stage 3 prostate cancer is diagnosed, staged, graded, and details the associated symptoms, treatments and prognosis.

Introduction

Prostate cancer is a form of cancer which begins in the prostate gland. Found in men, the prostate gland is located below the bladder. The function of the prostate is to produce a white, milky, alkaline fluid which makes up part of the volume of semen. During sex, this alkalinity helps neutralize acidic secretions found in the vaginal tract, prolonging the life of sperm and increasing the chance of fertilization.

As men age, cancerous cells may develop in the prostate. Over time, prostate cancer cells can multiply, forming tumors which may spread to, and affect, other parts of the body. In the earlier stages, prostate cancer often develops slowly.

The extent to which the cancer has progressed, can be categorized or 'staged'. When prostate cancer is stage 3, tumor within the prostate has extended through the cover (membrane) of the gland. The seminal vesicles, which are two glands near the prostate, may also be affected at this stage. The seminal vesicles are glands which also secrete fluid which partly makes up the volume of semen.

Stage 3 Prostate Cancer Symptoms

As stage 3 prostate cancer is 'locally advanced', and does not affect other parts of the body except in some cases the seminal vesicles, symptoms originate from the prostate gland and connected areas.

Stage 3 symptoms usually include urinary problems.

Urinary symptoms include:

  • weak flow of urine
  • problems starting urination
  • frequent urination - regular trips to the toilet at night time are a common symptom
  • interrupted flow of urine
  • a pain or burning sensation experienced during urination
  • blood in the urine

Symptoms of stage 3 prostate cancer can include sexual problems.

Sexual problems associated with prostate cancer include:

  • erectile dysfunction - a person has difficulty maintaining an erection or is unable to have an erection (impotent)
  • pain when ejaculating
  • blood in the semen (a condition known as hematospermia)

These symptoms will vary between people; they can also indicate other conditions including prostatitis (inflammation of the prostate gland) and benign prostatic hyperplasia (increased size of the prostate). If you are experiencing these symptoms seek medical help so an accurate diagnosis can be made and appropriate treatment given.

See also, 'Symptoms Of Prostate Cancer'.

Diagnosing Stage 3 Prostate Cancer

A diagnosis of stage 3 prostate cancer is normally given after a number of tests have been taken. This tests determine the course or spread of this disease. One or a combination tests are taken which can include imaging studies, surgical specimen (biopsy) and physical examination.

The results from these tests indicate the extent to which the disease has progressed; the physician may then use two recognized staging systems, TNM & Whitmore-Jewett, to stage the prostate cancer.

The 'TNM' staging system is a popular system used to stage prostate cancer. The initials of this system represent:

  • T - primary tumor : the size, spread and location of the tumor
  • N - lymph nodes: have the lymph nodes been invaded by cancer?
  • M - metastasis: has the cancer 'metastasized' and spread to other areas of the body?

Each category of this system, T, N & M, have subcategories used to grade the extent to which that category is affected.

As stage 3 prostate cancer extends through the prostate capsule (cover) it is classed as T3 (stage 3 tumor); a sub stage category, a or b, can also be applied.

Using the TNM staging system, Stage 3 prostate cancer can be:

T3a - cancer in the prostate has extended through the prostate cover; no other areas are affected.

or

T3b - cancer has extended through the prostate cover and has invaded the seminal vesicles; no other areas are affected.
(Reference: AJCC Cancer Staging Manual, 7th edition) ).

Similar to the TNM system, the Whitmore-Jewett system also uses a four stage system with sub stages. This system uses letters rather than numbers, e.g. Stage 3 prostate cancer under the Whitmore-Jewett system is known as Stage C prostate cancer. To avoid confusion, physicians may keep staging uniform and use numbers for this system.

Using the Whitmore-Jewett System, Stage 3/Stage C prostate cancer is either:

  • C1 - the tumor has extended through the membrane (cover) of the prostate gland
  • or
  • C2 - the tumor has extended through the membrane (cover) and the nearby seminal vesicles are affected.

As shown, both systems use the same criteria to classify prostate cancer as Stage 3.

To aid diagnosis, a physician may also use the Gleason Grading System. This system is used to assess how aggressive the cancer is. A sample of prostate tissue taken from biopsy is examined at a microscopic level. The arrangement of the glands reflect the aggressive nature of the cancer. Using this system, a grade is given on a scale of 1 to 5; this scale represents 5 different patterns of cells. If there is more than one grade within a sample, the two main grades are added to give a Gleason score which ranges from 2 to 10.

A Gleason grade 1, is given to samples with glands which are small and uniform; there is little space between them. Cancer cells can still be present in Grade 1 samples, despite the prostate tissue appearing normal. At the higher end of the scale, grade 5 is assigned to a pattern which has no recognizable glands; sheets of cells are shown instead.

Stage 3 prostate cancer is often at a Gleason Grade 3. A grade 3 pattern has tissue with recognizable glands. The cells, however, are darker, and there are signs that cells are leaving some of the glands and invading surrounding tissue. This indicates that the cancer has become more aggressive.

Stage 3 Prostate Cancer Treatment

Once the cancer is staged, a physician may use this information, along with results from the Gleason Grading System and other tests, to make an informed decision about treatment.

There is no one treatment which can reliably treat stage 3 prostate cancer. The type of treatment given is made on a case by case basis, but will often involve one or a combination of these treatments:

  • Hormone Therapy - known as Androgen Deprivation Therapy (ADT), this hormonal treatment reduces the levels of male hormones within the body, and can shrink tumors or reduce their rate of growth.
  • Surgery - radical prostatectomy is a surgical treatment for stage 3 prostate cancer. In this procedure, the prostate gland and seminal vesicles are removed.
  • Radiation Therapy - high energy radiation can be used to shrink tumors and kill cancer cells.

For stage 3 prostate cancer, a common treatment is hormone therapy (ADT) with radiation therapy.

Stage 3 Prostate Cancer Prognosis

A cancer is also staged so that a physician can give a prognosis. The term 'prognosis' refers to the likely outcome of the disease.

A reliable prognosis for stage 3 prostate cancer cannot be given. However, with treatment the prognosis is usually good. Factors such as the patients overall health, their Gleason and PSA* score can also influence the course of this disease.
*A higher level of prostate-specific antigen (PSA) may indicate prostate cancer.

The National Cancer Institute (NCI) survival statistics show that the 5 year survival rate for regional stage prostate cancer is almost 100%.

The NCI use a different staging system to the AJCC TNM system; cancers are grouped into categories of 'local', 'regional' and 'distant'.

Stage 3 prostate cancer falls into the 'regional' group; this system also shows that 5 year survivability of stage 3 prostate cancer is almost 100%. This is a similar figure to Stage 1 and Stage 2 prostate cancer.