Especially from the tumor spread results for treatment planning and prognosis important tumor stage. The individual prognosis depends on many factors and can be estimated using nomograms.
After the tests were completed, the clinical tumor spread according to the TNM-system dependent (see are investigation ) and the taken in prostate biopsy tissue histology (histological) assessed (see Classification ). Using the findings, you can make a classification in clinical (as determined by tests) tumor stages and groups with similar prognosis:
Staging
The clinical tumor stage is most easily cleaned after the tumor spread specify. This is usually done according to the TNM system, rarely by Whitmore-Jewett-American system (eg, T2b N0 M0 = B2, and details on both see the growth and spread ). A summary is understandable and easier to choose the right treatment and estimating prognosis:
- Locally limited prostate cancer: T1-2 N0 M0
- Locally advanced prostate cancer: T3-4 N0 M0
- Metastatic (advanced) prostate cancer: T1-4 and N1 and / or M1
- Stage I: T1 N0 M0 2a
- Stage II: T2b-c N0 M0
- Stage III: T3 N0 M0
- Stage IV: T4 N0 M0 or T1-4 N1 M0 or T1-4 N0-1 M1
Forecast
The position of an individual forecast (forecast) over the course of the disease is very difficult.It depends on numerous factors, including the age and health of the person concerned, the clinical tumor stage (see above), the biopsy report and the proposed treatment.
If left untreated, the disease usually continues slowly. The following table shows the average values for the risk of metastases (secondary tumors) and for mortality (mortality) of untreated patients depending on the clinical tumor spread according to the TNM system (after R. Hautmann, H. Huland: Urology Springer, Heidelberg 2006. , p.233):
| TNM stage | Metastases present at | Mortality (without treatment) | ||
| T1a | 0% | 2% in 5-10 years | ||
| T1b | 25% | 20% in 5-10 years | ||
| T2a | 15% | 20% in 5-10 years | ||
| T2c | 35% | 70% in 5-10 years | ||
| T3 | 50% | 75% in 5-10 years | ||
| N1-3, M1 | 100% | over 50% in 3 years |
- Tumor type: Adenocarcinoma
- Gleason score to 7a (= 3 +4)
- Helpap grading to GIIa
- Low or mäßiggradiges prostate cancer (low grade or intermediate grade)
- Low number of positive (infected) Punching cylinders (small tumor)
- Low proportion of the total tumor biopsy material (small tumor)
- Unilateral involvement of the prostate
- Large distance of the tumor to the prostate capsule
- No tumor ingrowth into the nerve sheath (no perineural infiltration)
- No tumor ingrowth into the seminal vesicles
| Group | T | N | M | PSA (ng / ml) | Gleason score | |||||
| I | T1a-c | N0 | M0 | <10 | Up to 6 | |||||
| T2a | N0 | M0 | <10 | Up to 6 | ||||||
| IIA | T1a-c | N0 | M0 | <20 | 7 | |||||
| T1a-c | N0 | M0 | As of 10 <20 | Up to 6 | ||||||
| T2a | N0 | M0 | As of 10 <20 | Up to 6 | ||||||
| T2a | N0 | M0 | <20 | 7 | ||||||
| T2b | N0 | M0 | <20 | Up to 7 | ||||||
| IIB | T2c | N0 | M0 | Each value | Each value | |||||
| T1-2 | N0 | M0 | As of 20 | Each value | ||||||
| T1-2 | N0 | M0 | Each value | From 8 | ||||||
| III | T3a-b | N0 | M0 | Each value | Each value | |||||
| IV | T4 | N0 | M0 | Each value | Each value | |||||
| T1-4 | N1 | M0 | Each value | Each value | ||||||
| T1-4 | N0-1 | M1 | Each value | Each value |
Risk assessment with nomograms
To improve the individual prediction, known as nomograms have been developed. Here are lists or charts that help can predict the pathological (identified by operation) TNM stage and various treatment outcomes and survival probabilities based on examination findings. An illustration is omitted here because they are constantly being revised. There are numerous nomograms, the most important are:
Partin Tables: They serve the pathological TNM stage predict (pT and pN). Depending on the PSA level and Gleason score tables from 2011 show for the clinical stage T1c, T2a, T2b and T2c, respectively, the probabilities for a localized tumor (pT2), a capsule exceeded (pT3a), a seminal vesicle invasion (pT3b) and lymph node metastasis (pN1).
Kattan nomograms: With the aid of such a failure to progression (a progression) predict the disease, depending on, for example, PSA level, Gleason score and clinical TNM stage. There are nomograms for the probability of progression-free after radical prostatectomy (after 5 and 10 years and after 7 years if it was already operating), LDR brachytherapy (after 5 years, seeradiotherapy ) and percutaneous irradiation (after 5 years, see radiotherapy ).
More nomograms: The probability of a localized tumor can be predicted with the nomogram of Steuber that for a lymph node involvement with the nomogram of Briganti.
Outlook: Special computer programs (ANN, artificial = artificial neural networks), a far more findings into account at the same time as nomograms. They promise so that in the future a more accurate risk assessment. In addition, numerous changes (eg in the form of biomarkers) can be determined in the excised tissue in the prostate biopsy, which based on the classical Typing and Grading (see classification beyond) and the prognosis might be able to facilitate future.
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