Prostate cancer staging
Cancer staging is a way to describe how much cancer is in your body and where it is located in your body. Prostate cancer staging helps determine how big your tumor is, whether it has spread, and where it has spread.
Knowing the stage of your cancer helps your cancer team:
- Decide the best way to treat the cancer
- Determine your chance of recovery
- Find clinical trials you may be able to join
Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.
PSA refers to a protein made by the prostate measured by a lab test.
- A higher level of PSA can indicate a more advanced cancer.
- The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.
A prostate biopsy is done in your doctor's office. The results can indicate:
- How much of the prostate is involved.
- The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.
Imaging tests such as a CT scan, MRI, or bone scan also may be done.
Using the results from these tests, your doctor can tell you your clinical stage. At times, this is enough information to make decisions about your treatment.
Surgical staging (pathological staging) is based on what your doctor finds if you have surgery to remove the prostate and perhaps some of the lymph nodes. Lab tests are done on the tissue that's removed.
This staging helps determine what other treatment you may need might. It also helps predict what to expect after treatment ends.
What the Stages Mean
The higher the stage, the more advanced the cancer.
Stage I cancer. The cancer is found only in only one part of the prostate. Stage I is called localized prostate cancer. It cannot be felt during a digital rectal exam or seen with imaging tests. If the PSA is less than 10 and the Gleason score is 6 or less, Stage I cancer is likely to grow slowly.
Stage II cancer. The cancer is more advanced than stage I. It has not spread beyond the prostate and is still called localized. The cells are less normal than cells in stage I, and may grow more rapidly. There are two types of stage II prostate cancer:
- Stage IIA is most likely found in only one side of the prostate.
- Stage IIB may be found in both sides of the prostate.
Stage III cancer. The cancer has spread outside the prostate into local tissue. It may have spread into the seminal vesicles. These are the glands that make semen. Stage III is called locally advanced prostate cancer.
Stage IV cancer. The cancer has spread to distant parts of the body. It could be in nearby lymph nodes or bones, most often of the pelvis or spine. Other organs such as bladder, liver, or lungs can be involved.
Staging along with the PSA value and Gleason score help you and your doctor decide on the best treatment, taking into account:
- Your age
- Your overall health
- Your symptoms (if you have any)
- Your feelings about side effects of treatment
- The chance that treatment can cure your cancer or help you in other ways
With stage I, II, or III prostate cancer, the main goal is to cure the cancer by treating it and keeping it from coming back. With stage IV, the goal is to improve symptoms and prolong life. In most cases, stage IV prostate cancer cannot be cured.
Loeb S, Eastham JA. Diagnosis and staging of prostate cancer. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 111.
National Cancer Institute website. Prostate cancer screening (PDQ) - health professional version. www.cancer.gov/types/prostate/hp/prostate-screening-pdq. Updated August 2, 2019. Accessed August 24, 2019.
Reese AC. Clinical and pathologic staging of prostate cancer. Mydlo JH, Godec CJ, eds. Prostate Cancer. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 39.