What is prostate cancer?

Localised prostate cancer

What is localised prostate cancer?

Localised prostate cancer refers to a tumour which is limited to the prostate and has not extended to other parts of your body. It may be a T1 or T2 tumour, depending on its size and where it is located in the prostate.

T1 means that the tumour is too small to be felt during a digital rectal examination (DRE) or seen on a scan. T1 tumours are confirmed with a biopsy and assigned an a, b, or c based on the analysis of the pathologist. A T2 tumour means that prostate cancer can be felt during a DRE, but is still limited to the prostate. Your doctor will also assign an a, b, or c to this stage, depending on the size of the tumour and whether it is in one or more lobes of the prostate (Fig. 1 and 2).

Fig. 1: A T1 prostate tumour is too small to be felt
Fig. 1: A T1 prostate tumour is too small to be felt during a digital rectal examination or seen on a scan.
Fig. 2: A T2 prostate tumour is limited to the prostate.
Fig. 2: A T2 prostate tumour is limited to the prostate.

Locally-advanced prostate cancer

What is locally-advanced prostate cancer?

Locally-advanced prostate cancer refers to a tumour which has spread outside of the prostate. It may be a T3 or T4 tumour, depending on where and how far outside of the prostate it has grown. T3 means that the tumour has grown just outside the prostate or to the seminal vesicles. A T4 tumour means that prostate cancer has invaded the bladder neck, the urinary sphincter, the rectum, or the pelvic floor (Fig.3 and 4).

Fig. 3: A T3 prostate tumour which has spread to the seminal vesicles.
Fig. 3: A T3 prostate tumour which has spread to the seminal vesicles.
Fig. 4: A T4 prostate tumour which has spread to the bladder neck, urinary sphincter, and rectum.
Fig. 4: A T4 prostate tumour which has spread to the bladder neck, urinary sphincter, and rectum.

Metastatic prostate cancer

What is metastatic prostate cancer?

If prostate cancer metastasizes, it usually spreads to the bones or the spine. At a later stage, prostate cancer may also spread to the lungs, the liver, distant lymph nodes, and the brain (Fig. 5). Most metastases cause a rise in the level of prostate-specific antigen (PSA) in your blood.

Metastases in the spine can cause symptoms like severe back pain, spontaneous fractures, or nerve or spinal cord compression. They can also be asymptomatic. In rare cases, lung metastases may cause a persistent cough.

Imaging can be used to detect metastases. Bone metastases can be seen on a bone scan. A CT scan may be recommended to get more detailed information about bone metastases, or to detect metastases in the liver, the lungs, or the brain.

Fig. 5: Metastatic prostate cancer can spread to the bones, spine, lungs, liver, or brain.
Fig. 5: Metastatic prostate cancer can spread to the bones, spine, lungs, liver, or brain.

Castration-resistant prostate cancer

What is castration-resistant prostate cancer?

Castration-resistant prostate cancer is a type of prostate cancer that usually develops during treatment for metastatic disease.

Hormonal therapy either stops the production or blocks the action of androgens. This is known as castration. When effective, hormonal therapy stops the growth of the tumour. This effect will not last and leads to castration-resistant prostate cancer. This generally happens 2-3 years after hormonal treatment started. Castration-resistant prostate cancer cannot be cured.

Castration-resistant prostate tumours need much lower levels of androgens to progress. This means that even when your body produces almost no androgens, the tumour and metastases continue to grow. These cancers are called castration-resistant, because they no longer respond to hormonal castration treatment.

In this type of cancer, the level of prostate-specific antigen (PSA) in the blood rises again. The doctor will diagnose castration-resistant prostate cancer if 3 tests in the space of 3 weeks show an increase in the PSA level in your blood. It can also be diagnosed if you experience symptoms caused by the growing tumour or metastases.