Prostate Cancer in Older Men

Dorothy A. Calabrese, MSN, RN, CURN, CNP


Urol Nurs. 2004;24(4) 

In This Article

Grading and Staging, and Progression of Prostate Cancer

If a biopsy is positive, the pathologist identifies the two most commonly occurring patterns (grades) of tumor in the biopsy tissue and adds those numbers together to give the cancer a Gleason score. Gleason scores range from 2 to 10, and are usually represented as a sum. For example, 3 + 4 = 7 for a Gleason score of seven. This is an important piece of information; the higher the Gleason score, the more aggressive the cancer. It is an important factor for determining treatment options. Table 2A and Table 2B further explain the Gleason scale.

Ca P is staged according to the TNM staging system. T refers to the primary tumor, N relates to regional lymph node involvement, and M refers to distant metastasis. Despite a relatively low PSA or favorable Gleason score, accurately staging the disease enables a better estimation of treatment options. See Table 3 for further description of the TNM staging system.

Prostate cancer can spread locally, lymphatically, or hematogenously. Local spread means the cancer has spread outside the prostate (extracapsular extension or into the seminal vesicles). Locally advanced prostate cancer may invade the bladder trigone, the bladder neck, or the urethra. Distant metastasis is usually to the regional lymph nodes or to bone. Visceral metastasis may occur to the lung, liver, and adrenal glands (Presti, 2004).


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