Prostate Cancer Stages and Grading

What Are the Stages of Prostate Cancer?

After a prostate cancer diagnosis, your doctor will then work to see if it has spread and, if so, how far. This process is called staging. The stage of prostate cancer describes how much cancer is in the body. Staging helps determine how serious the cancer is and the best way to treat it. 

How Do You Determine the Stage of Prostate Cancer?

If you’ve been diagnosed with prostate cancer, your doctor will conduct tests to see how far cancer has spread. The results of your biopsy will determine the tests you need, which include:

  • Digital rectal exam (DRE)
  • PSA (prostate-specific antigen) test
  • Transrectal ultrasound
  • MRI of the prostate
  • CT Scan of the abdomen and pelvis
  • Nuclear medicine bone scan to see if cancer has spread to your bones
  • Surgery to examine the lymph nodes in your pelvis

How Many Stages of Prostate Cancer Are There?

There are multiple methods for staging prostate cancer, and the number of stages depends on the particular grading scale. The two types of staging for prostate cancer are clinical staging and pathologic staging:

Clinical staging.

The clinical stage is based on the results of the urologist’s physical examination of the prostate through a digital rectal exam and any other tests that are needed.

Pathologic staging.

Following surgery to remove the prostate, a pathologist will assign the Gleason score and stage. Pathologists use the TNM Staging System to describe how far prostate cancer has spread. This system describes the tumor (T), lymph node (N), and metastasis (M) to lymph nodes, bones, and other organs.

What Are the Prostate Cancer Grading Systems?

There are two grading systems, the Gleason system, and the TNM system, which are outlined below:

Gleason Scoring System

To find a Gleason score, the tumor cells from the biopsy are looked at under a microscope. A number is assigned to them based on how abnormal they appear. The scale goes from 1 (non-aggressive) to 5 (very aggressive). The numbers of the two most common patterns are added together to create a Gleason score. 

  • Grade Group 1 (Gleason 6 or lower). Cells look similar to healthy cells (low-grade cancer)
  • Grade Group 2 & 3 (Gleason 7). The tumor tissue is moderately differentiated, moderately aggressive, and likely to grow, but may not spread quickly (high-grade cancer)
  • Grade Group 5 (Gleason 9 & 10). Cells look very different from healthy cells (highest- grade cancer)

TNM System

The TNM staging system was developed and is maintained by the American Joint Committee on Cancer AJCC and the Union for International Cancer Control. It’s the most commonly used staging system by medical professionals worldwide. This system classifies prostate cancer in four stages with some stages split into more specific sub-stages. The TNM system stands for:

  • T (tumor). What’s the size of the main area of prostate cancer?
  • N (nodes). Has it spread to any lymph nodes? If so, how far?
  • M (metastasis). How far has the prostate cancer spread?

The results are combined to determine the stage of cancer for each person. 

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What Are the 4 Stages of Prostate Cancer?

There are four stages: I-IV. The stage provides a common way of describing cancer, which helps doctors to work together to plan the best treatments. 

Stage I Prostate Cancer

  • Your doctor can’t feel the tumor during a DRE or see it with an imaging test. It hasn’t spread to any nearby lymph nodes or elsewhere in the body
  • The tumor is in one-half or less of only one side of the prostate
  • Gleason Group 1
  • PSA less than 10

Stage II Prostate Cancer

  •  Stage IIA 
    • The doctor may or may not be able to feel the tumor during DRE or see it on an imaging test, it hasn’t spread to any nearby lymph nodes or elsewhere in the body
    • The tumor can touch more than one half of one lobe of the prostate but doesn’t involve both lobes
    • Gleason Group 1
    • PSA less than 20
  • Stage IIB
    • The doctor may or may not be able to feel the tumor during DRE or see it on an imaging test, it hasn’t spread to any nearby lymph nodes or elsewhere in the body.
    • The tumor can be in one or both lobes of the prostate
    • Gleason Group 2
    • PSA less than 20
  • Stage IIC
    • The doctor may or may not be able to feel the tumor during DRE or see it on an imaging test, it hasn’t spread to any nearby lymph nodes or elsewhere in the body.
    • The tumor can be in one or both lobes of the prostate
    • Gleason Group 3 or 4
    • PSA less than 20
    • Cells appear more abnormal than stage IIB

Stage III Prostate Cancer

  • Stage IIIA
    • The doctor may or may not be able to feel the tumor during DRE or see it on an imaging test, it hasn’t spread to any nearby lymph nodes or elsewhere in the body.
    • Gleason Group 1-4
    • PSA at least 20
  • Stage IIIB
    • Cancer has grown outside the prostate and might have spread to the seminal vesicles or into other tissue next to the prostate, it has not spread to any nearby lymph nodes or anywhere else in the body.
    • Gleason Group 1-4
    • Any PSA level
  • Stage IIIC
    • Cancer may or may not have grown outside the prostate and into nearby tissues, hasn’t spread to nearby lymph nodes or anywhere else in the body.
    • Gleason Group 5
    • Any PSA level

Stage IV Prostate Cancer

  • Stage IVA
    • Cancer may or may not have grown into tissues near the prostate, has spread to nearby lymph nodes, hasn’t spread anywhere else in the body.
    • Any Gleason Group
    • Any PSA level
  • Stage IVB
    • Cancer may or may not have grown into tissues near the prostate, may or may not have spread to lymph nodes, and has spread to other parts of the body, such as distant lymph nodes, bones, or other organs.
    • Any Gleason Group
    • Any PSA level

Learn More About Prostate Cancer Stages with Baptist Health

Knowing what stage you’re in is important because it plays a large role in choosing the best treatment. Contact us to learn more about prostate cancer progression and the stages of prostate cancer. 

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