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Prostate Cancer Stages: What Do They Mean?

Time: 2019-03-29


After prostate cancer is diagnosed, your cancer will be staged. Staging tells you how advanced the cancer is, how big it is in the prostate, and whether it has spread to other parts of the body, such as the nearby lymph nodes, liver, and bone.

Knowing the stage of your cancer provides important information about the best treatment options, the likelihood that the cancer can be cured, or whether it is so slow growing that you can safely pursue active surveillance (watch and wait), with routine monitoring by your physician.

Several staging systems exist. They vary in complexity and use. In general, the stage at which your cancer was initially diagnosed is the stage that doctors will use throughout, even if cancer moves to a more advanced stage.


Prostate Cancer Stages Range from 1 to 4

The most easy-to-understand staging system groups cancer into stages 1 to 4, with stage 1 the earliest prostate cancer and stage 4 when the cancer has spread throughout the body. This is used for many cancers. Your doctor is likely to tell you your stage of cancer using this system.

Stage 1: Prostate cancer is limited to a small part of the prostate.

  • Often, the cancer is found as a result of needle examination of tissue for another reason, such as benign prostatic hypertrophy (BPH), also known as an enlarged prostate, or because of an elevated result on a prostate specific antigen (PSA) test, which uses PSA levels as an indicator of potential cancerous growth.
  • Cancer cells are only found in a small part of the prostate. The cells look like normal cells and the prostate feels normal with a digital rectal exam.
  • PSA is less than 10.
  • Gleason score (discussed below) is less than 6.

Stage 2: Prostate cancer involves more of the prostate and a lump is detectable in an exam.

This category is divided into two stages: stage 2A and stage 2B.

In stage 2A, features are like stage 1, with these changes:

  • PSA is at least 10, but less than 20.
  • Gleason score is 6 or 7 but can be lower if diagnosis was by needle biopsy for conditions other than cancer.
  • Cancer can be found in one half or less of the prostate lobe or more than one lobe.

Stage 2B cancer means that:

  • The prostate cancer is more extensive, extending to opposite sides of the prostate. It might be detectable with a digital rectal exam. In this instance, the PSA can be any level and the Gleason score can range from 2 to 10.
  • Alternatively, cancer remains undetectable in the digital rectal exam and imaging tests. PSA is 20 or more and the Gleason score is between 2 and 10.
  • Yet another way this can manifest is with a Gleason score of 8 or more, PSA at any level, but imaging and DRE do not pinpoint the cancer.

Stage 3: Prostate cancer extends to the outer layer of the prostate and may involve the seminal vesicles. These point to a locally advanced cancer that will grow and spread.

  • PSA can be any value and the Gleason score is between 2 and 10.

Stage 4: The cancer is at its most advanced and has spread via the blood, lymph nodes, and potentially other organs.

  • The cancer may have spread to the lymph nodes or bone.

Recurrent Prostate Cancer

Recurrent cancer is cancer that comes back after curative treatment. It might come back where it was initially diagnosed or elsewhere in the body. When this occurs, men may need to go through the same tests that they had when initially diagnosed.

TNM Staging: More Precise — and More Complicated

A more involved but precise staging method is endorsed by the American Joint Committee on Cancer. The precision of this system helps doctors select patients for research and treatment on the basis of the biology of the cancer.

TNM stages categorize

  • The size of the tumor;
  • The involvement of lymph nodes;
  • Metastasis and cancer grade.

The system is a bit complicated and is thoroughly described in public information provided by the American Cancer Society. (2)

Risk Assessment: Establishing Risk Groups

In recent years, doctors and physician groups have been classifying patients into three risk groups: high, intermediate, and low risk. Risk groups are based on considering the TNM stage, PSA, and Gleason score.

What Constitutes Low-Risk Prostate Cancer?

Low-risk prostate cancers grow very slowly. You will be low risk if your PSA is less than 10, you have a Gleason score no higher than 6, and a T stage between T1 and T2A. Low-risk patients have considered candidates for active surveillance, radical prostatectomy, or radiation.

What Are Intermediate- or Medium-Risk Cancers?

Medium-risk cancers probably won’t grow or spread for a few years, but curative therapy (prostatectomy or radiation) is recommended. In addition, they are usually treated with less than six months of a gonadotropin-releasing hormone medication (hormone therapy). Your doctor will put you in this category if you have a PSA between 10 and 20, a Gleason score of 7, and a T stage of T2B.

What Are High-Risk Cancers?

A high-risk cancer means that your cancer is expected to grow and spread in the next few years. If you have a PSA greater than 20, a Gleason score between 8 and 10, and a T stage of T2B, you will be considered high-risk. Men at high risk are often given radiation and a longer period of hormonal therapy. Developing better treatments for high-risk patients is a key goal of prostate cancer research. (2)

Genomic Testing

Inroads in prostate cancer biology have led to new molecular tests that, when considered along with risk groups, Gleason score, and PSA, can give information on the aggressiveness of the tumor. Molecular testing is recommended in men who want to choose active surveillance, have low-risk, or intermediate-risk disease with a life expectancy of more than 10 years or who have advanced disease.