This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on June 23, 2022.
Staging prostate cancer is a sometimes-complex process that involves multiple tests, measurements and other factors. The aim is to determine the size, extent and aggressiveness of the cancer.
This article will cover:
There are two types of staging for prostate cancer.
Clinical staging: This is based on the results of pre-surgery procedures such as a prostate-specific antigen (PSA) test, a digital rectal exam (DRE), a Gleason score (a grade based on how cancer cells behave on a micro level) and imaging tests. A doctor uses these results to determine the stage of the cancer and decide whether to recommend further diagnostic exams, such as a magnetic resonance imaging (MRI) scan.
Pathological staging: This type of staging is based on information uncovered after prostate surgery. The prostate tissue is examined to get a more detailed, and sometimes more accurate, stage of the disease.
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting points—the cancer’s grade and Gleason score.
Cancer grade: When the pathologist examines prostate cancer cells under a microscope, the most common type of cells get a grade of 3 to 5. The area of cancer cells in the prostate are also graded. The higher the grade, the more abnormal the cells.
Gleason score: The two grades are added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography (PET) scan or computed tomography (CT) scan.
Doctors use the results of all these tests to help determine the stage of the prostate cancer, or how far it has progressed. Widely used staging criteria is based on the TNM system developed by the American Joint Committee on Cancer.
The three key components of the TNM system are:
The stage of cancer will help doctor and patient determine the most appropriate options for prostate cancer treatment.
Prostate cancer stages range from 1 through 4:
Stage 1 is assigned to early-stage prostate cancer when the cancer cells are still localized to the prostate, meaning they have not spread outside of the prostate gland.
Stage 2 prostate cancer means the cancer has not spread outside the prostate gland, but it's more at risk of growing than cancers in stage 1. Stage 2 prostate cancer has three substages, listed below.
Stage 3 prostate cancer refers to a locally advanced cancer, which means the cancer cells have spread outside their site of origin. The tumor has progressed and is more likely to grow and spread, with results showing a high Gleason score and elevated PSA levels. This stage also has three substages, listed below.
Stage 4 prostate cancer is an advanced-stage prostate cancer that has spread (metastasized) to distant sites or to the lymph nodes. It's further divided into two substages, listed below.
Identifying the stage of cancer not only helps the care team determine a treatment plan, it also helps predict a potential prognosis. This is achieved by calculating the percentage of people with prostate cancer who survive five years or longer after diagnosis compared to people who don’t have that type of cancer. It’s important to remember that this is only a statistic based on all people with prostate cancer several years in the past, so individual patient experiences may vary.
The National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program bases the survival rate for prostate cancer on where the cancer started and how far the cancer has spread, as detailed below.
Localized: The cancer hasn’t spread beyond the tissue in which it developed. The five-year relative survival rate for localized prostate cancer is 100 percent.
Regional: The cancer has spread to nearby tissues or lymph nodes. The five-year relative survival rate for regional prostate cancer is 100 percent.
Distant: The cancer has spread to farther reaches of the body. The five-year relative survival rate for distant prostate cancer is about 34 percent.
The overall five-year relative survival rate for prostate cancer is 97.1 percent, according to the SEER program.
Keep in mind that the survival rate for prostate cancer depends on a variety of factors, including the patient’s age, overall health and the extent of the disease, so always talk to the care team about the patient’s individual prognosis.
To help understand the progression of prostate cancer, discuss these questions with the care team: