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
As men get older, they have a lot of new worries to deal with, from hair loss, weight gain, perhaps even erectile dysfunction. In addition, cancer is one of the biggest concerns that older men face, especially prostate cancer, which is the leading cause of cancer death in men over 75. Younger men may not be very familiar with their prostate, the walnut-shaped gland that wraps around the urethra, the tube that carries urine out of the body. But as they get older, the prostate can start to cause problems. Men over the age of 60 are at increased risk for prostate cancer, especially if they're of African descent, they have a father or brother with the disease, or they eat a lot of burgers and processed meats in their daily diet. It can be hard to pinpoint prostate cancer symptoms, because they usually start late in the disease and they can mimic symptoms of a benign, enlarged prostate, which is also more common in older men. Symptoms like a slow urine stream, dribbling, blood in the urine, or straining while urinating can be signs of either condition. An enlarged prostate can also confuse the results of a PSA test, which is used to screen for prostate cancer. So, if your doctor thinks you might have prostate cancer, you may need a biopsy, which is a procedure that removes a small piece of prostate tissue and sends it to the lab to check for cancer. Then a scoring system called the Gleason grade is used to tell how fast your cancer might spread. Your Gleason grade will help decide what treatment you get. Early-stage prostate cancers that haven't spread are often removed with surgery, and then treated with radiation therapy to kill any remaining cancer cells. Prostate cancer surgery may affect your ability to have sex and control urine, so talk about these issues with your doctor before you have the procedure. Because prostate cancer tends to grow very slowly, your doctor may want to just monitor you with PSA tests and biopsies, and avoid treatment unless the cancer starts to spread. Prostate cancer that has spread is usually treated with surgery, chemotherapy, or hormone therapy. If your doctor discovers prostate cancer in its early stages, before it spreads, it's pretty easy to treat, and even cure. Treatments can also slow down prostate cancer that's spread, and extend your survival. Before you have to deal with a prostate cancer diagnosis, ask your doctor for ways to prevent and screen for the disease. Eating a healthy, low-fat diet that's high in healthy omega-3 fatty acids might help lower your risk. There are also drugs called finasteride and dutasteride that are used in some men to prevent prostate cancer. Talk with your doctor about the pros and cons of these drugs, as well as the possible benefits and risks of having your PSA levels tested.
How Prostate Cancer Staging is Done
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. 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 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: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 152.
National Cancer Institute website. Prostate cancer screening (PDQ) - health professional version.
Reese AC. Clinical and pathologic staging of prostate cancer. Mydlo JH, Godec CJ, eds. Prostate Cancer. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 39.
Last reviewed on: 7/26/2021
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.