Stage 1 Prostate Cancer

What is stage 1 prostate cancer?

Stage 1 prostate cancer is localized, early-stage prostate cancer, meaning the tumor is small and confined to the prostate gland and has not reached the lymph nodes or spread to other parts of the body.

A stage 1 prostate tumor has no symptoms, cannot be felt, and only involves half of one side of the prostate or even less. Additionally, cancer cells appear to be the same as normal cells [¹]

What are the subtypes of stage 1 prostate cancer?

Over 93% of cases of stage 1 prostate cancer are adenocarcinomas. [²]

Other types are rare but include:

Sarcomas
Transitional cell carcinomas
Small cell carcinomas
Neuroendocrine tumors

Recent research suggests prostate cancer starts as a precancerous condition known as prostatic intraepithelial neoplasia (PIN). [³]

Stage 1 prostate cancer staging and diagnosis

Prostate cancer staging

In general, the TNM system is used to describe and classify cancers, including {cancer type}, where:

T (tumor) describes the size and location of the tumor

N (nodes) indicates whether or not it has spread to nearby lymph nodes

M (metastasis) describes if and how far cancer has spread from its origin

How common is stage 1 prostate cancer?

Prostate cancer follows skin cancer, as the second most common cancer in Americans, with an estimated 268,000 diagnosed every year. Globally, 1.4 million men are diagnosed, making it the fourth most common cancer worldwide. [⁶] [⁷]

73% of these cases are stage 1, with 60% diagnosed in men over 65. Early-stage prostate cancer is rarely seen in men under 40. Black men in the US and Caribbean have been seen to have higher incidences, 73% more than their Caucasian counterparts. [⁶] [⁷]

How is stage 1 prostate cancer diagnosed?

Stage 1 prostate cancer is difficult to diagnose because it rarely presents. Also, given how slowly it grows, it can remain undetected for years. In most cases, stage 1 prostate tumors are found by accident when men have surgery to relieve the symptoms of an enlarged prostate gland.

Screening has been suggested to be the best option for early diagnosis of stage 1 prostate cancer. The most common methods include the prostate-specific antigen (PSA) test and digital rectal exam (DRE). Other diagnostic tools include prostate gland imaging and biopsy.

However, these screening options are not completely accurate and have been known to give false-positive and false-negative results. Both cases can lead to confusion, with false positive patients being over-treated and false negative patients being undertreated. [⁸]

Recent studies have suggested that while the PSA and DRE can detect more stage 1 prostate cancer cases, it does not necessarily lower the death rate as treatment is usually conservative. However, these are preliminary results. As prostate cancer is a slow-growing disease, studies are still underway to determine if early screening reduces overall deaths in the long run. [⁹] [¹⁰]

Another problem with early screening is overdiagnosis, where asymptomatic, non-lethal cases of stage 1 prostate are treated unnecessarily even though there is no indication to suggest future problems. Such cancers can stop growing on their own. This leads to unnecessary therapies and mental anxiety. [¹¹]

Total Prostate-specific antigen (PSA) test

PSA is a blood protein produced by both cancerous and normal prostate gland cells. It can attach to blood protein or circulate unattached in the body. Research suggests that as a prostate tumor grows, so does the total amount of PSA in the body; however, there is no definitive cut-off number.

In case of an abnormal PSA result, doctors recommend other types of PSA tests before committing to a biopsy. These include:

Percent Free PSA, which tests the level of unattached PSA. The lower the value, the higher the chance of having prostate cancer

Complex PSA, which tests the level of attached PSA but is not widely used

Combination PSA compares the results from various PSA tests to determine a score that better diagnoses a prostate tumor. These tests are given below:

The Prostate Health Index combines total, free, and complex PSA levels
The 4Kscore test compares various PSA levels with other blood compounds such as human kallikrein 2

However, it is important to understand that PSA can be high for reasons other than prostate cancer, as the conditions below can increase PSA in the blood:

An enlarged prostate
Advanced age
Ejaculation
Riding a bicycle
Certain medications
Certain urologic procedures, such as a prostate cystoscopy or biopsy

Furthermore, certain medications and dietary supplements can mask high PSA levels even in men with prostate cancer.

Digital rectal exam (DRE)

In a DRE, a doctor feels for any bumps or hard areas on the prostate by inserting a gloved, lubricated finger in the rectum. As prostate tumors are known to normally begin in the back of the prostate gland, they can be felt this way. While this exam is uncomfortable, it is not painful. [⁸]

Compared to a PSA test, a DRE is less effective at detecting a stage 1 prostate tumor but has been seen to identify cancer in men with a normal PSA level.

Prostate Gland Imaging

While imaging options are available, such as an MRI or a transrectal ultrasound (TRUS), they are often unable to show stage 1 prostate tumors as they are too small.

Prostate Biopsy

A prostate biopsy is only recommended when consecutive PSA tests are abnormal and in the higher ranges. A sample from the prostate gland is taken and examined under a microscope. However, in most stage 1 prostate cancer cases, the cancerous cells are too close to normal cells, making them nearly impossible to recognize.

Stage 1 prostate cancer symptoms

Generally, stage 1 prostate cancer does not present with any symptoms. In the rare cases that it does, symptoms are similar to benign diseases like an enlarged prostate and prostatitis [¹²], such as:

Frequent urination
Slow, weak, or irregular urine stream
Difficulty starting or stopping urination
Painful urination
Blood in semen or urine
Erectile dysfunction
Painful ejaculation
Pain or pressure in the rectum

Stage 1 prostate cancer treatment

Stage 1 prostate cancer is treated by a multidisciplinary team that includes urologists, pathologists, oncologists, radiologists, surgeons, and physicians. They will consider a variety of factors to determine the best approach.

Generally, doctors prefer to take a conservative approach due to the slow growth of Stage 1 prostate cancer. If there are no signs or symptoms, stage 1 prostate growth is deemed low risk. Doctors will continue to monitor without intervention, a treatment known as active surveillance. In such cases, the adverse effects of chemotherapy, radiation, or surgery pose more danger to a man’s quality of life than the tumor and are avoided.

If the stage 1 prostate tumor has a higher risk of growing and spreading through the body, several treatment options are available. The most common is the surgical removal of the prostate gland via a radical prostatectomy. [¹³]

Stage 1 prostate cancer removal surgery

As stage 1 prostate cancer has not spread outside the prostate gland, removing the gland is the most effective method of eliminating cancer from the body and preventing recurrence. A radical prostatectomy is performed where the gland and surrounding tissue are removed, including lymph nodes and seminal vesicles [¹⁴].

There are two approaches to performing radical prostatectomy. Both can be performed under either general anesthesia or regional anesthesia, e.g., spinal anesthesia. [¹⁵]

Laparoscopic radical prostatectomy via smaller incisions that use specialized tools to remove the prostate. This approach is more common as it is less invasive than open, with studies suggesting the recovery is better. [¹⁶]

Open radical prostatectomy is more traditional; patients are kept under general anesthesia. There are two types of surgical incisions:

Retropubic - an incision in the lower abdomen, from the navel to the pubic bone
Perineal – an incision in the skin between the anus and the scrotum, i.e., the perineum. This approach is used less as it can lead to future erectile issues and because nearby lymph nodes cannot be reached. It is a shorter surgery, less painful, and has a shorter recovery than the retropubic approach.

Regardless of the approach, recovery takes 2 -3 months, during which the patient will experience temporary urine leakage and bladder hypersensitivity. Furthermore, many physical activities are prohibited during this time, so the abdomen wall and urethra can heal from the surgery.

Side effects of a prostate gland removal surgery include incontinence, loss of bladder control, erectile dysfunction, changes or pain with orgasm, loss of fertility, lymphedema, changes in penile length, and increased risk of inguinal hernias.

Other types of treatment for stage 1 prostate cancer

Other treatment avenues for those unsuitable for surgery include radiation therapy, hormone therapy, and chemotherapy. Also, given the subtype of stage 1 prostate cancer, a patient may be recommended these therapies in conjunction with prostate gland removal surgery.

Radiation therapy is reserved for men with high-risk early-stage prostate cancer or positive margins after gland removal surgery. Research suggests recurrence can drop as low as 50% with radiation post-radical prostatectomy, but optimal timing is still under debate. [¹⁷] Options include external beam radiation (EBRT) and brachytherapy

Hormone therapy, also known as androgen suppression therapy, reduces male hormones such as testosterone and dihydrotestosterone, which have been shown to increase the growth of prostate cancer cells. [¹⁸]. Hormone therapy is recommended in the following cases:

After prostate surgery, if cancer cells have been found in nearby lymph nodes
If cancer comes back after surgery or radiation therapy
Before radiation to shrink the cancer
For treating early-stage prostate cancer in men who do not want surgery, but the long-term benefits of this therapy have not been established

Different types of hormone therapy include drugs and interventions such as surgical castration, medical castration, anti-androgens, androgen suppressors, and androgen blockers.

Chemotherapy is advised only in cases where the early stage prostate cancer causes symptoms such as pain. Otherwise, it is recommended for later stages in patients who have exhausted all other options. [¹⁹]

Can stage 1 prostate cancer be cured?

Unlike other forms of cancer, stage 1 prostate cancer is almost always curable following a radical prostatectomy. However, curability can vary depending on the sub-type, risk of further growth, and patient factors such as general health, age, and co-morbidities.

Prognosis: Stage 1 prostate cancer survival rate

Stage 1 prostate cancer patients have a better prognosis with a prolonged survival rate that exceeds patients in later stages. Prognosis considers two metrics, survival and quality of life. Survival for stage 1 prostate cancer is reflected in 5-year, 10-year, and 15-year survival rates that indicate the percentage of patients alive after diagnosis. Quality of life is concerned with the ability of a stage 1 prostate cancer patient to continue to live a healthy and enjoyable life in terms of health conditions and medical interventions they are going through. For a general prognosis chart of prostate cancer, including stage 1 cancer, refer to [⁷].

Stage 1 prostate cancer survival rate

The 5-year survival rate for men with early-stage prostate cancer, i.e., stage 1 prostate cancer, is estimated at 100% [⁷]. Patients diagnosed in their late 60 are more likely to die from illnesses other than prostate cancer. [²⁰]

In fact, further research has shown that the 10-year survival rate for early-stage prostate cancer remains above 95%, and only when it spreads beyond the prostate gland does the rate begin to dip toward 86% [⁷]

Stage 1 prostate cancer recurrence rate

Biochemical recurrence a occurs in less than 25% of cases. As mentioned above, with post-radiation therapy, the chances of reoccurrence can be diminished.

Biochemical recurrence refers to increased PSA levels in the blood following prostate removal surgery or radiation. It is also known as PSA failure or biochemical relapse. It is an indication that may suggest the cancer is back. [²¹]

Stage 1 prostate cancer growth rate

How fast does stage 1 prostate cancer grow? Early-stage prostate cancer is slowly growing and can be years before it is felt in a rectal exam or seen in diagnostic imaging.

Lifestyle changes for preventing and managing prostate cancer

While the cause of stage 1 prostate cancer is still unknown, certain risk factors exist that can increase a man’s risk of developing the disease. Some of these, such as age, ethnicity, and family history, cannot be changed. Others, such as weight and lifestyle choices, can be managed to prevent the development of prostate cancer.

Weight: men who are overweight in their 50's are 54% more likely to develop prostate cancer. [²²]. Therefore doctors recommend keeping weight in a healthy range.
Diet is the most important factor that can be controlled to prevent prostate cancer. A diet rich in whole grains, fruits, lean meats, and vegetables is recommended to promote prostate health. Men are advised to avoid red meat, sugar, and energy-dense drinks and limit salt. [²³]
Alcohol consumption should be limited or eliminated completely. However, limited consumption of red wine has been suggested to slightly lower the risk of lethal prostate cancer. [²⁴]
Smoking should be avoided completely as it is associated with aggravating tumor growth and worsening prostate cancer prognosis, even in men who have stopped smoking for over 10 years. [²⁵]

Conclusion

Takeaways

An estimated 12.6% of men will be diagnosed with prostate cancer in their lifetime. [⁷]. Therefore, they must consider making lifestyle changes early in adulthood to reduce their long-term chances of diagnosis and begin screening after 50. This is especially true for those with family history and African descent.

Given its nature, stage 1 prostate cancer is not considered fatal. It can be managed effectively even if patients are unwilling or unsuitable for surgery. While the surgical removal can cure stage 1 prostate cancer, it does mean the cancer will not come back. Additionally, many long-term effects must be taken into consideration. The best course of action for patients with early-stage prostate cancer depends on their unique medical history and lifestyle goals, which must be assessed before determining a course of treatment.