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Prostate cancer stages

Staging is the process of determining how much a cancer has grown and whether it has spread to lymph nodes or other organs. Staging a cancer is a critical step and often helps determine treatment options designed to target that specific disease.

Staging prostate cancer is a sometimes-complex process that involves several tests, measurements and other factors intended to determine the size, extent and aggressiveness of the cancer. These metrics may be used in combination to determine the cancer’s stage. Components involved in staging prostate cancer may include (anchor links):

  • TNM system
  • Gleason score
  • Prostate specific antigen (PSA) test
  • Digital rectal exam (DRE)

Types of staging

There are two types of staging for prostate cancer:

Clinical: This is based on the results of a PSA test, a DRE, Gleason score and imaging tests a patient may have had. A doctor uses the results of these tests and exams to determine the stage of the cancer and decide whether further diagnostic exams, such as an MRI, are needed.

Pathological: 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.

Staging tools

TNM system

The American Joint Committee on Cancer (AJCC) has developed a uniform system for describing the stages of prostate and several other cancers. This system allows doctors to describe how advanced a cancer is and to share that information with one another in a meaningful way. The three key components of the TNM system are:

T (tumor) describes the tumor’s size, location and how deep it has grown into the tissue.

N (node) indicates whether cancer cells have spread to nearby lymph nodes, or the channels connecting the lymph nodes.

M (metastasis) refers to whether the cancer cells have spread to distant organs or tissue.

Each category of the TMN system has subcategories that describe in more detail the extent of the disease. For instance, T0 means no evidence of a tumor, while T2 describes the tumor confined to the prostate.

Gleason score

In the 1960s, pathologist Donald Gleason, MD, established a system to measure the extent of cell mutations in a cancer. The higher the score, the more aggressive the cancer may be. In some cases, Gleason scores from two areas of the prostate may be combined to determine a grade group, which helps measure a patient’s prognosis. For instance, those in Gleason grade group 1 are cancers with a score of six or less, while group 5 cancers have scores of nine or 10. The higher the grade group, the worse the cancer prognosis. The Gleason score is used to help determine the grade and grade group of a tumor, which is intended to indicate its aggressiveness.   

PSA test

Prostate-specific antigen (PSA) is a protein produced by the prostate that helps turn semen into a liquid. A PSA test measures the level of the protein in the blood. An elevated level of PSA may be a sign of prostate cancer, but it may also be a sign of other noncancerous conditions affecting the prostate, such as prostatitis, which is inflammation of the prostate. To confirm the reasons for the elevated PSA tests, a doctor may also recommend other tests, such as a DRE or a biopsy, to look for other signs of cancer.

Learn more about laboratory tests to help diagnose cancer

Digital rectal examination

Men and women may receive a DRE as part of an annual physical. In examining a man’s prostate, a doctor inserts a lubricated finger into the rectum to feel the adjacent prostate, looking for bumps or other abnormalities and to measure its size.

Learn more about diagnostic tools for prostate cancer

Prostate cancer staging

Like many other cancers, prostate cancer has four stages, with each stage divided into sub-stages, depending on the results of the screening and diagnostic tests, as well as other factors. For instance, stage II prostate cancer is subdivided into stages IIA, IIB or IIC depending on a variety of factors.

If you have been diagnosed with prostate cancer, your doctor can explain the specific stage of your disease. Also, the American Cancer Society has a comprehensive chart that explains all prostate cancer stages and sub stages.

Next topic: How is prostate cancer diagnosed?