Dr. Ali Kasraeian, your second opinion expert, delivers knowledge, trust, and compassion. An important part of evaluating prostate cancer is determining the stage, or how far the cancer has spread. Knowing the stage helps define prognosis and is useful when selecting therapies. The most common system is the four-stage TNM system (abbreviated from Tumor/Nodes/Metastases). Its components include the size of the tumor, the number of involved lymph nodes, and the presence of any other metastases. The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate. In the TNM system, clinical T1 and T2 cancers are found only in the prostate, while T3 and T4 cancers have spread elsewhere.Several tests can be used to look for evidence of spread. These include computed tomography to evaluate spread within the pelvis, bone scans to look for spread to the bones, and endorectal coil magnetic resonance imaging to closely evaluate the prostatic capsule and the seminal vesicles. Bone scans should reveal osteoblastic appearance due to increased bone density in the areas of bone metastasis—opposite to what is found in many other cancers that metastasize.
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The Gleason System
After a prostate biopsy, a pathologist looks at the samples under a microscope. If cancer is present, the pathologist reports the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow. The Gleason system is used to grade prostate tumors from 2 to 10, where a Gleason score of 10 indicates the most abnormalities. The pathologist assigns a number from 1 to 5 for the most common pattern observed under the microscope, then does the same for the second-most-common pattern. The sum of these two numbers is the Gleason score. Regardless of who you see, it is important to get a second opinion for prostate cancer due to the number of available treatment options. Prostate cancer treatment options vary based on the individual so it is absolutely critical to get a couple different opinions on what is right for you. Every specialist claims that there treatment option is the most effective with the fewest possible side effects, but the truth is that agendas aside, the right treatment option depends on the individual and cancer. Some cancers could even go untreated, so consult an expert and obtain a second opinion. Insurance covers the cost and if not, we will work with you to keep the costs down, just make sure to consult a second opinion expert.