Prostate Cancer Staging Explained: Why an Accurate Diagnosis Matters

Katherine Banwell:

How is prostate cancer staged, and how does it impact care options?

Dr. Daniel Sentana Lledo:

Yeah, that’s a great question and actually one that many of my patients ask me. So, I would say that any cancer is traditionally staged based on size of a tumor and where it has spread to. Prostate cancer is a little differently. So, staging is still important, but what we’ve discovered over time is that there is a continuum of risk. And so, what I mean by that is that not necessarily because you have stage I or stage II, you should be managed like this. There’s more to it. And some of the things that add into it is, what was your PSA number when you started? What were the imaging findings or the digital rectal, what did you find there? And oftentimes, the thing that’s most critical is, how aggressive was the cancer under the microscope after you did a biopsy?

So, while there is the traditional staging of stage I, stage II, stage III, and stage IV, or metastatic, in reality, as I said at the beginning, we think of it as localized. And within that, what is the risk of the cancer spreading over time? And then a whole different bucket is people who, from the beginning or later on, have metastasis or cancer spread.

Katherine Banwell:

Why is an accurate diagnosis so important?

Dr. Daniel Sentana Lledo:

For many reasons. I think principle is for patients to know what to expect, and when you’re hit with the word cancer, it’s really hard to process anything else that’s going on. But not all cancers created equally, fortunately, and this is especially true in prostate cancer, where we know that there are disease stages where you certainly have cancer and it’s important to think about it, but it is not going to harm you anytime soon. While other situations, you need treatment very, very imminently. And so, it’s important to know exactly where you’re at in that stage because as a patient, as someone living with cancer, you want to know, how worried should I be about this? How is this going to impact my day-to-day?

From our end, obviously, not only that, but also it helps us know how much treatment you really need, and how do we intensify treatment with a combination of approaches, or can we just do something as simple as monitoring and re-biopsying? So, that’s why really understanding for a patient to know where they are in that scale of needing to monitor versus something that needs immediate treatment is really important.

Katherine Banwell:

You mentioned about patients asking some questions. Are there specific questions that patients should be asking about their diagnosis and test results?

Dr. Daniel Sentana Lledo:

Yes. So, I think first, I want every patient to understand, why did this happen? And many times, we actually don’t have an answer for prostate cancer, but there is a subset of people that have risk factors that are from the environment and others that are inherited, meaning that their family or their parents potentially pass them on. So, I think it’s important for anyone who gets cancer to try to understand as much as possible, why did this happen? Even though, as I said, we don’t always find the right answer there.

With regards to testing, I would say anytime your provider is recommending a test or a procedure, it’s very important for someone with prostate cancer to think, “Okay, why is this necessary? How is it going to advance my care?” And it might not be completely apparent. I would say that some tests are easier to explain than others, but I think at the very least you should ask your provider and hear about it because some tests are more crucial than others. And I do this, I have things that I need the first visit that I meet a patient, and others that I signpost that we’ll need this test later on, but I don’t need it right this moment to make a decision.