1. STAGES OF PROSTATE CANCER
99 Route 37 West Toms River, NJ 08755 (732) 557-3120www.newjerseyck.com

2. Prostate Cancer Overview
Possible Signs of Prostate Cancer:
Weak or interrupted flow of urine
Frequent urination
Trouble urinating
Pain or burning during urination
Blood in the urine or semen
Persistent pain in the back, hips, or pelvis
Painful ejaculation
¨ The prostate is a
walnut-sized gland
located in a man’s
lower abdomen that
controls the flow of
urine and semen.
¨ Prostate cancer is a
leading cause of
cancer death among
American men, second
only to lung cancer.
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

3. Diagnosing Prostate Cancer
Prostate Cancer can be diagnosed by:
¨ Digital Rectal Exam (DRE) – examination of
the rectum.
¨ Prostate-specific antigen (PSA) test –
measures the level of PSA in the blood. PSA
may be found in an increased amount in the
blood of men with prostate cancer.
¨ Transrectal Ultrasound Biopsy – provides a
picture of the prostate for the doctor to
analyze.
¨ Gleason Score – determines how likely
prostate cancer is to spread.
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

4. The TNM Staging System
A staging system describes how far a cancer has spread.
The most widely used staging system for prostate cancer is
the American Joint Committee on Cancer (AJCC) TNM
system.
The TNM system for prostate cancer is based on 5 key
pieces of information:
¤ The extent of the primary tumor (T category)
¤ Whether the cancer has spread to nearby lymph nodes (N
category)
¤ The absence or presence of distant metastasis (M category)
¤ The PSA level at the time of diagnosis
¤ The Gleason Score, based on the prostate biopsy (or surgery)
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

5. Prostate Cancer - Stage I
¨ Cancer is found in the prostate only.
¨ Cancer is microscopic and cannot be felt during the
DRE or seen on imaging tests.
¨ Cancer is found in one-half or less of one lobe of
the prostate.
¨ PSA level lower than 10 ng/mL.
¨ Gleason Score is 6 or lower.
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

6. Prostate Cancer - Stage IIA
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com
¨ Cancer is more advanced than
Stage I but has not spread outside
the prostate.
¨ The cells are usually more
abnormal and may tend to grow
more quickly.
¨ Cancer is found in more than half
of one lobe of the prostate.
¨ PSA level is lower than 20 ng/mL.
¨ Gleason Score is 7 or lower.

7. Prostate Cancer - Stage IIB
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com
¨ Cancer is found in opposite sides of the prostate.
¨ Cancer cannot be felt during a DRE and is not
visible by imaging.
¨ The tumor has not spread outside the prostate.
¨ PSA level is 20 ng/mL or higher.
¨ Gleason Score ranges from 2 to 10.

8. Prostate Cancer - Stage III
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com
¨ Cancer has spread beyond the
outer layer of the prostate.
¨ Cancer may have spread to
nearby tissues like the seminal
vesicles.
¨ PSA can be any level.
¨ Gleason Score can range from
2 to 10.

9. Prostate Cancer - Stage IV
¨ Cancer has spread
(metastasized) beyond the
seminal vesicles to nearby
tissues or organs such as
the rectum, bladder or
pelvic wall.
¨ Cancer has spread to
distant parts of the body,
which may include other
lymph nodes or bones.
Prostate cancer often
spreads to the bones.
¨ Cancer has spread to
nearby lymph nodes
¨ PSA can be any level.
¨ Gleason score can range
from 2 to 10.
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

10. Prostate Cancer Treatment
Treatment Options
Active Surveillance
Surgery
External-Beam Radiation Therapy
Brachytherapy
Proton Therapy
Stereotactic Body Radiation Therapy
¨ Treatment options depend on:
¤ The stage of the cancer
¤ The patient’s age and health
¤ The patient’s Gleason Score
¤ Whether the cancer is recently
diagnosed or recurring
¤ The patient’s prostate-specific
antigen (PSA) levels
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

11. CyberKnife® SBRT Treatment Process
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com
¨ Prior to stereotactic body radiation therapy with CyberKnife, small
tissue markers known as fiducials are implanted in the prostate to
help pinpoint the tumor location throughout each treatment.
¨ About a week later, patients are fitted with a custom body mold of
soft material that they lie on during treatments. The fitting process is
painless.
¨ This treatment process
includes
¤ Consultation appointment
¤ Pretreatment procedures
¤ CyberKnife treatment
¤ Follow-up

12. Additional Resources
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com

13. Our Center
Opened in 2011, New Jersey CyberKnife at the J. Philli Citta Regional Cancer
Center is active in clinical research. New Jersey CyberKnife opened a clinical trial
in collaboration with the University of Pittsburgh to evaluate stereotactic body
radiation therapy for low, intermediate and high-risk prostate cancer patients.
Results from the trial will add to the body of clinical research examining
stereotactic body radiation therapy for prostate cancer and will help doctors
analyze effects and outcomes to improve prostate treatment protocols. Medical
Director Dr. David D’Ambrosio has also published several peer-reviewed research
papers on prostate cancer.
99
Route
37
West
Toms
River,
NJ
08755
(732)
557-­‐3120
www.newjerseyck.com
Medical Director: Dr. David Ambrosio
Chairman of Radiation Oncology at Community Medical Center: Dr. Rajesh Iyer
CyberKnife Nurse: Debbie Moriarty, RN, MSN, OCN
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