Stages of Prostate Cancer

Karl Marvin Tan MD

September 11, 2022

When diagnosing prostate cancer in a male, a doctor will look at the progression of the disease in terms of both its growth and its dissemination. There are four stages total, with stage four representing the most sophisticated and aggressive form. The optimal course of treatment and prognosis for each patient is decided based on how far along they are in these stages.

Prostate cancer staging is defined by the results of one or more diagnostic tests. A digital rectal exam (DRE), prostate-specific antigen (PSA), and imaging studies are examples of such diagnostics. Bone scans, CT scans, MRIs, and transrectal ultrasounds are all examples of imaging examinations.

How Is Prostate Cancer Staged?

To identify the exact stage of a patient’s prostate cancer, doctors usually begin by using what we call a TNM staging system. This system helps doctors in defining different aspects concerning the cancer’s growth.

  • (Tumor) – The size and extent of the Tumor
  • N (Node) – Whether the cancer has reached the Lymph Nodes
  • M (Metastasis) – Whether the cancer has spread (Metastasized) to other organs in the body

A score is assigned to each of these categories based on a predetermined list of criteria. For instance, if you have a score of T1, it indicates that the doctor is unable to detect or feel the tumor, but that it was discovered by a biopsy or a very high PSA number. A T3 score, on the other hand, would suggest that the cancer has spread beyond the prostate and is now affecting other organs.

When the TNM categories have been computed, the attending physician will next combine the patient’s total TNM score with the patient’s PSA levels and the Gleason score, which measures the level of hostility exhibited by the tumor cells. When all of these factors are considered together, a stage can be determined for the patient’s cancer.

What Do the Prostate Cancer Stages Mean?

Stage 1 Prostate Cancer

In stage 1, there are already cancerous cells, but the tumor is small and only affects one area. The PSA levels and Gleason scores are still low, and there may not be any obvious symptoms yet.

At this point, a physical exam or an imaging test might not be able to find the tumor yet. It has not spread to other parts of the body. When prostate cancer is found at this stage, almost everyone will be alive after 5 years.

Routine tests might be able to find the cancer at this early stage, so it can be treated right away.

Stage 2 Prostate Cancer

In this case, a physical exam or imaging test may or may not be able to find the tumor. In the same way, it hasn’t spread past the prostate yet. But the cancer cells may now have a higher Gleason score, which could mean they are growing faster.

  • Stage IIA – The tumor cannot be felt yet in a DRE by the doctor. The PSA is at a moderate level, and the cancer cells are differentiated (matured) well. Stage IIA can also include larger tumors that are confined to the prostate but are well-differentiated.
  • Stage IIB – The tumor may now be large enough to be felt or detected by the doctor during a DRE. PSA levels are still moderate, but the cancer cells are now moderately differentiated. (Less differentiation, or maturity, of the cancer cells can indicate a more aggressive cancer.)

Stage 3 Prostate Cancer

In Stage 3, the prostate cancer may or may not have spread beyond the prostate, but the other indicators are high (Gleason, PSA). Along with that, the tumor is fairly aggressive.

Stage 4 Prostate Cancer

This means the tumor has spread to one or more other parts of the body like the bladder, lymph nodes, lungs, liver, or bones. At this stage, treatments may be able to slow down or shrink the tumor.

There are many exciting advances in successfully treating prostate cancer at all stages. The survival rate of men with this disease is increasing exponentially thanks to new technologies and treatments.

Get screened for prostate cancer to ensure early diagnosis and treatment.