Preoperative assessment of the stage of the prostate cancer is made based on the above-mentioned tests.

T-stage: primary tumour

Tx - primary tumour cannot be assessed T0 - no evidence of primary tumour T1 - clinically unapparent tumour; not palpable or visible by per rectum imaging T1a - incidental tumour found in histopathological tests after transurethral resection of the prostate or after operational adenectomy: found in 5% or less resected tissue T1b - as above; found in more than 5% resected tissue T1c - tumour identified histopathologically by a needle biopsy (because of high PSA) T2 - tumour confined within the prostate gland T2a - tumour involves less than half of one lobe T2b - tumour involves more than half of one lobe only T2c - tumour involves both lobes T3 - tumour extends through the prostatic capsule T3a - extracapsular extensions (unilateral) T3b - extracapsular extensions (bilateral) T3c - tumour invades seminal vesicles T4 - tumour is fixed, invades adjacent structures other than seminal vesicles T4a - tumour invades bladder neck and/or external sphincter and/or rectum T4b - tumour invades levator muscles and/or pelvic wall N-stage: regional lymph nodes

Nx - regional lymph nodes cannot be assessed N0 - no regional lymph node metastases N1 - metastasis to a single regional lymph node with the diameter under 2cm N2 - metastasis to a single regional lymph node with the diameter > 2cm but < 5cm N3 - metastases to regional lymph nodes with the diameter over 5cm M-stage: remote metastases

Mx - remote metastasis cannot be assessed M0 - no remote metastases M1 - remote metastases M1a - non-regional lymph nodes M1b - bones M1c - other sites According to Whitmor-Catalon classification, grades A, B, C, and D correspond to T1, T2, T3 and T4 of TNM classification respectively.

Degree of cancer differentiation:

Degree of differentiation is defined according to 2 classifications: by Mostofi and by Gleason.

Mostofi’s classification uses a 3-grade assessment of differentiation dependent on the degree of cell anaplasia – grading (G1-G3). The higher grade, the lower differentiation of cancer tissue, the greater atypy and at the same time, malignancy. In the case of a 10-grade Gleason system, the two extreme histological images in the preparation are assessed and then, added to produce a final grade.

PSA is a proteolyctic enzyme responsible for sperm melting. It is mainly produced by glandular epithelium, it might be also produced in organs such as salivary glands, pancreas and mammary gland and by clear cell carcinoma. Commonly used norm is the following: 0-4 ng/ml. Such concentration of PSA is found among 97% of men over 40. The level over 12 ng/ml is always connected with pathology. Difficulties with diagnosis are found among patients who have this level between 5-10 ng/ml because it may both stem from the prostate cancer or a mild overgrowth of the prostate, which causes the necessity of diagnostic methods use, such as TRUS. This test makes it possible to determine PSA density (PSAD - PSA density) - PSA concentration converted to prostate volume unit. It should be under 0.15 ng/ml/g. In the case of prostate cancer differentiation and mild overgrowth of prostate, free to total PSA (PSA F/T) is used. If it is over 20%, one may assume the presence of cancerous cells in the gland. PSA level does not correlate well enough with the natural development of the prostate cancer. However, it is useful as a prognostic factor after the treatment applied and in prognosis determination. However, high final levels indicate low survival rate.

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