Staging of Prostate Cancer

The most common staging system used to describe the extent of involvement of prostate cancer is the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM System describes the extent of the primary tumor (T category), whether the cancer has spread to nearby lymph nodes (N category) and the presence or absence of distant metastasis (M category). Stage groupings can then be determined along with the Gleason score and total PSA. The range progresses from Stage I (least advanced) to Stage IV (most advanced). Prostate cancer stages can be complex and difficult to understand.
 

Prostate Cancer Stages: Growth and Spread
Prostate cancer grows locally within the prostate, often for many years. Eventually, prostate cancer extends outside the prostate. Prostate cancer can spread beyond the prostate in three ways:

  • By growing into neighboring tissues (invasion)
  • By spreading through the lymph system of lymph nodes and lymph vessels
  • By traveling to distant tissues through the blood (metastasis)

Prostate cancer stages describe the precise extent of prostate cancer’s spread.

 

Prostate Cancer Stage I

  • T1, N0, M0, Gleason score 6 or less, PSA less than 10
    Tumor is not felt on digital rectal exam, cancer was found either through a needle biopsy or incidentally during a transurethral resection of the prostate. Cancer is limited to the prostate and has not spread to the lymph nodes.
    or
  • T2a, N0, M0, Gleason score of 6 or less, PSA less than10
    Tumor can be felt on digital rectal exam, nodule is in one-half or less of only one side of the prostate. Cancer has not spread to lymph nodes.

 

Prostate Cancer Stage II

  • T1, N0, M0, Gleason score of 7, PSA less than 20
    Tumor is not felt on digital rectal exam, has not spread to the lymph nodes and shows no evidence of metastasis.
    or
  • T1, N0, Mo, Gleason score of 6 or less, PSA at least 10 but less than 20
    Tumor is not felt on digital rectal exam, has not spread to the lymph nodes and show no evidence of metastasis.
    or
  • T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
    Tumor can be felt on digital rectal exam, it is only on one side of the prostate. If It is felt to be great than 50% on one side of the prostate it is classified as 2b.

 

Prostate Cancer Stage IIB

  • T2c, N0, M0, any Gleason score, any PSA
    Tumor can be felt on digital rectal exam and is present on both sides of the prostate, it has not spread to the lymph nodes and shows no evidence of metastasis.
    or
  • T1 or T2, N0, M0, any Gleason score, PSA or 20 or higher
    or
  • T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA

 

Prostate Cancer Stage III

  • T3, N0, M0, any Gleason score, any PSA
    Tumor has begun to spread outside of the prostate and may have spread to the seminal vesicles, but has not spread to the lymph nodes and shows no signs of metastasis.


Prostate Cancer Stage IV

  • T4, N0, M0, any Gleason score, any PSA
    Tumor has spread to tissues next to the prostate such as the bladder, rectum or wall of the pelvis, has not spread to nearby lymph nodes and shows no signs of metastasis
    or
  • Any T, N1, M0, any Gleason score, any PSA
    or
  • Any T, any N, M1, any Gleason score, any PSA
    Evidence that the cancer has spread to more distant sites in the body.

Accurately identifying the prostate cancer stage is extremely important. Prostate cancer stage helps determine the optimal treatment, as well as prognosis. For this reason, it’s worth going through extensive testing to get the correct prostate cancer stage.