第三阶段前列腺癌是一种先进但仍可治疗的疾病形式。像其他类型的癌症一样，前列腺癌被分类为阶段based on how far the disease has progressed.

Stage 1 prostate cancer means the cancer is still confined to the prostate gland, while stage 4 — the most advanced form of the disease — means the cancer has spread to other parts of the body. About80 to 85 percentof all prostate cancers are diagnosed in stages 1, 2, or 3.

At stage 3, cancer cells have penetrated the thin capsule that surrounds the prostate gland. The malignant cells may have spread to tissue beyond the prostate, or the cancer may still affect the prostate only.

With proper treatment, about95 percentof individuals with stage 3 prostate cancer will survive for at least 5 years.

Early on, you may notice few if anyprostate cancer symptoms。大多数局限性前列腺癌患者会l not have symptoms. By stage 3, some of the first signs of trouble may be certain urinary concerns, including:

  • a weak stream
  • more frequent urination
  • incontinence
  • nocturia, or having to get up and pee in the middle of the night
  • blood in your urine or semen
  • feeling like you have to pee, but not passing anything

During stage 3, you may also experience pain or discomfort in the pelvic area. Erectile dysfunction may occur by stage 3.

If the doctor conducting a digital rectal exam feels any bumps or hard areas on the prostate, you may be advised to have a biopsy. Likewise, if a PSA test shows elevated PSA levels, your doctor may suggest a biopsy. An MRI may also be used to help determine whether prostate cancer is present.

Prostate cancer requires a biopsy to confirm a diagnosis. A needle biopsy, in which a thin needle is inserted quickly into the prostate to obtain a small piece of tissue, is usually ordered if there are other indications of prostate cancer.

If cancer cells are found, they may be given a Gleason score and your doctor may assign a stage to your cancer.

From there, the decision about how to proceed should be made after a thorough review of the risks and benefits of all treatment options.

Describing a cancer in stages helps doctors and their patients identify the seriousness of the disease and how best to treat it.

Staging system

这system most commonly used was devised by the American Joint Committee on Cancer. It’s known as the TNM system, and it’s based on how much the cancer has spread.

TNM system

  • T描述主要的程度tumor
  • Nto state whether the cancer has spread to the lymphnodes
  • Mto state whether the cancer has转移（或传播）到体内其他组织

PSA levels

Doctors also rely on yourPSA levelsto help stage prostate cancer.PSAstands for prostate-specific antigen, a protein produced by the prostate.

High PSA levels are often, though not always, indicative of prostate cancer. PSA levels are measured in nanograms of PSA per milliliter of blood (ng/mL).

PSA results

LowerPSA values通常被认为是安全的。大多数实验室使用4.0 ng/ml的PSA作为“正常”的截止，但是在适当的临床背景下必须考虑每个值。

Gleason score

Prostate cancer staging may also include aGleason score，这是估计癌症侵略性的一种方式。格里森评分实际上是由两个分数组成的，该分数通过检查了一小部分前列腺组织。

A Gleason score is commonly understood as a series of patterns. The first number is the most common pattern seen and must be more than 50 percent of the tissue. The second number is the second most common pattern and must be less than 50 percent, but more than 5 percent, of the tissue.

分数看起来如何

Each grade is a number between 1 and 5. You may have a Gleason score of 7, or a 3+4. The higher the score, the more aggressive the cancer is likely to behave.

Though there are variations within each stage, the following is a basic outline of the four stages of prostate cancer.

Stage 1

  • This is the least advanced cancer, where it hasn’t moved out of the prostate gland.
  • 这5-year survival rate is nearly 100 percent.
  • 这PSA level is usually under 10 ng/mL, and the Gleason score is typically a 6 or lower.

Stage 2

  • 这cancer is still contained in the prostate.
  • 这doctor, however, may be able to feel abnormal changes to the prostate during a digital rectal examination.
  • At stage 2, the PSA score is usually less than 20 ng/mL, and the Gleason score can be 6, 7, or 8 (grade group 2, 3, 4).
  • 5年生存率也接近100％。

Stage 3

癌症正在前列腺外生长，但可能没有到达直肠，膀胱或其他器官。阶段3癌症也分为字母亚组：

  • 第3A阶段。这tumor has pushed through the outer capsule on one side of the gland. The PSA level is often 20 ng/mL or higher, and the Gleason score is usually 8 or less.
  • 阶段3B。这tumor has pushed through the capsule with seminal vesicle, rectal, or urethral sphincter invasion. There is no lymph node involvement. The PSA may be any level, and the Gleason score is likely to be 8 or less.
  • Stage 3c.这tumor can be contained or is growing outside the prostate. There is no lymph node involvement. The PSA can be at any level and the Gleason score is 8 or less.
  • If the cancer hasn’t spread far, the 5-year survival rate at stage 3 is still almost 100 percent.

Stage 4

  • Stage 4 cancer is divided into letter subgroups depending on whether it has invaded the nearby lymph nodes (stage 4a) or whether it has reached distant lymph nodes or other organs, tissue, or even the骨头(stage 4b).
  • This is the most advanced form of prostate cancer.
  • 任何PSA水平和格里森评分都是可能的。
  • 这5-year survival rate is about 30 percent 。

What 5-year survival rates mean

重要的是要了解生存率的含义。在这种情况下，该数字是指在初次诊断后仍居住五年的人的百分比。这意味着那些人已经生活at leastfive years after diagnosis. Many survival rates do not look beyond that timeframe.

Prostate cancertreatmentsrange from active surveillance, which is a watch and wait approach to the slow-growing cancer, to invasive procedures. Procedures include surgery to remove the prostate and brachytherapy, which is the injection of radioactive “seeds” into the prostate to kill cancer cells.

治疗options for stage 3 prostate cancer include:

  • 外束辐射和激素治疗
  • external beam radiation and brachytherapy, along with hormone therapy
  • 根治性前列腺切除术,which is the surgical removal of the entire prostate and some surrounding tissue, including the seminal vesicles
  • a pelvic lymph node dissection, which involves removing lymph node tissue

这se approaches are known as “local” treatments because they treat the cancer in or close by the prostate gland.

A note about hope

Prostate cancer is usually a slow-growing cancer, so even if it is diagnosed at stage 3, there are very effective treatments available. And new developments in prostate cancer treatment are being made every year.

Prostate cancer is the most common type of cancer among men in the United States and should therefore be a subject that men learn about and address with their doctors once they reach adulthood.

由于前列腺癌的生长缓慢，因此常规的前列腺筛查通常会在早期阶段感染该疾病。这 American Cancer Society recommends the following timeframe for initial prostate screenings:

  • 年龄40岁的男性，有一个以上一级亲戚（兄弟或父亲），他们早年患有前列腺癌
  • age 45 for men at high risk of developing prostate cancer, including African Americans and anyone with a first-degree relative who was diagnosed with cancer younger than 65 years of age
  • age 55 to 69 for men who are of average risk of prostate cancer

这issue of prostate cancer screenings is a somewhat controversial one, so talk with a primary care physician or urologist about the pros and cons of getting a screening at your age.

Stage 3 prostate cancer, while an advanced form of the disease, can often be successfully treated. It may involve surgery or other procedures that can affect an individual’s urinary and sexual function.

However, stopping prostate cancer from potentially spreading throughout the body could be worth the costs of aggressive cancer treatment. Your age, health, and how prostate cancer and its treatment may affect your quality of life should be part of a thorough conversation with your doctor.