Stage 2 Prostate Cancer

What is Stage 2 Cancer of the Prostate?

Prostate cancer is a type of cancer that affects the prostate gland, which is part of the male reproductive system. The prostate gland is responsible for producing semen and is located below the urinary bladder and in front of the rectum. Prostate cancer is one of the most common types of cancer in men, and it can be classified into different stages based on its severity.

Stage 2 prostate cancer is the second stage localized cancer that has not spread beyond the prostate gland. The cancer is still confined to the prostate gland at this stage and has not spread to other body parts.

Stage 2 prostate cancer is usually detected during routine prostate cancer screening, which involves a blood test called prostate-specific antigen (PSA) [¹]. If the results of these tests suggest that a man may have prostate cancer, he will be referred to a specialist for further testing.

What are the subtypes of stage 2 prostate cancer?

According to the National Cancer Institute, there are three subtypes of stage 2 prostate cancer which are deduced based on the location of cancer and the Gleason score [2], which are:

Stage 2A: The cancer grows in half or less than half of one lobe of the prostate gland. The PSA level is between ten to 20, and the Gleason score is six or lower.
Stage 2B: The cancer grows in more than half of one lobe of the prostate gland or both lobes. The PSA level is less than 20, and the Gleason score is seven.
Stage 2C: The cancer grows on both sides of the prostate. The PSA level is less than 20, and the Gleason score is between seven to eight.

The subtypes of stage 2 prostate cancer are important because they help doctors determine the best treatment options for each patient.

Stage 2 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 location and size of tumors.
N (nodes) indicates whether or not it has spread to nearby lymph nodes
M (metastasis) describes if and how far the cancer has spread from its origin

How Common is Stage 2 Prostate Cancer?

Prostate cancer is one of the most common cancers that affect men. In 2022, more than 268,490 American men were diagnosed with prostate cancer. 60% of cases were observed in patients aged 65 or older. Among prostate cancer patients, more than 84% suffer from stage 2 prostate cancer.

How is Stage 2 Prostate Cancer Diagnosed?

Diagnosis of stage 2 prostate cancer typically involves several tests and procedures, including:

1. Prostate-Specific Antigen (PSA) Test

The PSA test is a blood test that measures the level of PSA in the blood. PSA is a protein formed by the prostate gland. High PSA levels show the presence of prostate cancer, but it is not definitive. Elevated PSA levels also occur due to non-cancerous conditions such as prostatitis or benign prostatic hyperplasia (BPH).

2. Digital Rectal Exam (DRE)

During a DRE, the healthcare practitioner inserts a lubricated, gloved finger in the rectum for any abnormalities in the prostate gland, such as lumps or hard areas.

3. Transrectal Ultrasound (TRUS)

A TRUS uses sound waves to create an image of the prostate gland. A small probe is inserted into the rectum, and the sound waves bounce off the prostate, creating an image.

4. Biopsy

If the PSA test, DRE, or TRUS indicates the presence of cancer, a biopsy may be necessary. During a biopsy, a small sample of prostate tissue is removed and examined under a microscope.

The biopsy may be done under local anesthesia, where a needle is inserted through the rectum or perineum (the area between the scrotum and anus) to collect tissue samples. Alternatively, a transperineal biopsy may be done under general anesthesia, where the needle is inserted through the perineum.

Stage 2 Prostate Cancer Symptoms

Prostate stage 2 cancer symptoms can be similar to those of other prostate problems, such as an enlarged prostate or prostatitis. However, if you experience any of the following symptoms, it is important to see a doctor:

Frequent urination
Difficulty urinating
Pain or burning sensation when urinating
Blood in the urine or semen
Pain in the back, hips, or pelvis
Erectile dysfunction

It is important to note that not everyone with stage 2 prostate cancer will experience symptoms. That is why regular prostate cancer screening is essential.

Stage 2 Prostate Cancer Treatment

There are several treatment options for stage 2 prostate cancer, and the choice of treatment depends on various factors, including the age and health of the patient, the size and location of the tumor, and the patient's personal preferences.

Stage 2 Prostate Cancer Primary/First-Line Treatment

The primary/first-line treatment for stage 2 prostate cancer is usually surgery or radiation therapy [³]. Surgery involves removing the entire prostate gland and some surrounding tissue, called a radical prostatectomy [⁴]. Radiation therapy involves using high-energy rays or particles to kill cancer cells [⁵]. There are two types of radiation therapy: external beam radiation therapy and brachytherapy.

External beam radiation therapy is the most common type of radiation therapy for prostate cancer. It involves directing high-energy radiation beams from outside the body to the prostate gland. The treatment is typically given five days a week for several weeks [⁶]. Brachytherapy involves placing small radioactive seeds directly into the prostate gland. The seeds are left in place permanently and gradually release radiation over time [⁷].

Other Types of Treatment for Stage 2 Prostate Cancer

In addition to surgery and radiation therapy, there are several other types of treatment for stage 2 prostate cancer, including:

Active surveillance: This is a "watchful waiting" approach, where the doctor monitors the cancer with regular PSA tests, DREs, and biopsies [⁸]. If the cancer starts to grow, treatment may be necessary.
Hormone therapy: This type of therapy reduces the amount of testosterone in the body, as prostate cancer cells need testosterone to grow [⁹]. Hormone therapy can be used alone or in combination with chemo and radiation at the same time.
Chemotherapy: This type of therapy uses drugs to kill cancer cells. Chemotherapy is typically used for advanced or metastatic prostate cancer but may be used for stage 2 prostate cancer in certain situations.
Immunotherapy: This therapy uses drugs that help the immune system identify and attack cancer cells.
Cryotherapy: Cryotherapy is a procedure that involves freezing the prostate gland to destroy cancer cells. This treatment is typically reserved for men not candidates for surgery or radiation therapy.
High-Intensity Focused Ultrasound (HIFU): HIFU is a non-invasive treatment that uses high-energy ultrasound waves to destroy cancer cells in the prostate gland. This treatment is typically used for men with early-stage prostate cancer who are not candidates for surgery or radiation therapy.

Is stage 2 cancer curable?

The primary treatment options discussed above are effective in treating early-stage prostate cancer. Thus, chances of curing stage two cancer are high. However, it is important to note that there is no definitive cure for prostate cancer, and the cancer can recur even after successful treatment. Regular follow-up with a urologist is essential to monitor for any cancer recurrence.

Prognosis: Stage 2 Prostate Cancer Survival Rate

Stage 2 prostate cancer survival rate

Stage two prostate cancer is highly survivable if diagnosed early on. Prostate cancer stage 2 survival rate for five years is 96.8%, meaning almost 97 out of 100 patients will survive the first five years [¹⁰]. More data revealed that 73% of survivors had localized cancer, while 14% of survivors had regional cancer that spread to regional lymph nodes.

Additionally, new treatment methods currently undergoing clinical trials show promising results in increasing patients' stage 2 cancer survival rates [¹¹]. Moreover, analysis of radiotherapy treatment showed that event-free cancer survival rates were high, reaching around 88% for localized prostate cancer [¹²]. Moreover, the ten-year cancer survival rates are around 86.8% [¹³].

Stage 2 Prostate Cancer Recurrence Rate

Despite the availability of effective treatment methods for stage 2 prostate cancer, there are significant chances of recurrence. According to John Hopkins Medicine, the cancer recurrence rate for stage 2 prostate cancer is around 20% to 30% after the five-year mark [¹⁴]. Moreover, research showed that tumor grade two and three prostate cancer recurrence rates were around 7.3% [¹⁵]. Similar studies show that HIFU treatment has low cancer recurrence rates but not zero [¹⁶].

Stage 2 prostate cancer growth rate

Cancer growth rates are measured through increases in PSA values and help understand how long you can live with cancer without treatment. Generally, prostate cancer is slow-growing and can take significant time to develop and show symptoms. However, early-stage cancer can grow quickly. One research studied the double time of prostate cancer in the early stages in patients that did not receive treatment. The study evaluated PSA values over 48 months and found that the values increased in 86% of the patients.

Moreover, the doubling time of PSA values was higher in patients with higher prostate cancer stages. 79% showed a doubling time of more than 24 months. Thus, the study concluded that the growth rate of prostate cancer is constant by extremely slow [¹⁷].

Lifestyle changes for preventing and managing prostate cancer

While there is no surefire way to prevent prostate cancer, lifestyle changes can be made to reduce the risk of developing and help manage the disease to increase stage 2 cancer life expectancy.

Maintain a Healthy Weight

Being overweight or obese increases the risk of developing prostate cancer. Therefore, maintaining a healthy weight through regular exercise and a balanced diet can help reduce this risk. Incorporating aerobic exercises, such as brisk walking, cycling, or swimming, for at least 30 minutes a day can also help keep your weight under control and reduce the risk of developing prostate cancer [¹⁸].

Eat a Healthy Diet

A diet rich in fruits, vegetables, whole grains, and lean protein sources, such as fish, chicken, and legumes, has reduced prostate cancer risk. Additionally, limiting the consumption of red meat and high-fat dairy products can help reduce the risk of developing the disease [¹⁹].

Quit Smoking

Smoking has been linked to an increased risk of developing prostate cancer [²⁰] and other types of cancer. Quitting smoking is one of the most important lifestyle changes a person can make to reduce their risk of developing prostate cancer.

Reduce Alcohol Consumption

Drinking alcohol, particularly beer, has been associated with an increased risk of developing prostate cancer [²¹]. Men should limit their alcohol intake to two drinks per day.

Get Regular Exercise

Exercise has been shown to reduce the risk of developing prostate cancer and improve overall health and quality of life [²²]. Men should aim for at least 150 minutes of exercise per week.

Get Screened

Regular prostate cancer screenings are an important part of managing the disease. Men over 50, or those with a family history of prostate cancer, should talk to their doctor about getting screened.

Manage Stress

Chronic stress has been linked to an increased risk of developing prostate cancer [²³]. Relaxation techniques like meditation or yoga can help reduce stress levels and improve overall health.

Take Supplements

Evidence suggests that certain supplements, such as vitamin D, selenium, and lycopene, may help reduce the risk of developing prostate cancer [²⁴]. However, men should talk to their doctor before taking any supplements.

Conclusion

Takeaway

Stage 2 prostate cancer is an intermediate stage of prostate cancer that has grown beyond the confines of the prostate gland. While the cancer has not spread to other parts of the body, it is still essential to seek prompt medical attention if you experience any symptoms. Treatment options for stage 2 prostate cancer may include active surveillance, surgery, radiation therapy, or hormone therapy. Your doctor will work with you to determine the best treatment plan based on your needs and health status.