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The 4 Stages of Prostate Cancer

Prostate Cancer

When a man is diagnosed with prostate cancer, the next step is to determine whether it has spread (metastasized) and how much. This is called staging, and prostate cancer has four stages.

In the United States, doctors typically use the American Joint Committee on Cancer (AJCC) TNM (Tumor, Node, Metastasis) staging system for prostate cancer and other forms of cancer. For prostate cancer, this system is based on five important factors:

  • The extent of the primary tumor
  • Whether the cancer has spread to lymph nodes in the immediate area
  • Whether the cancer has spread to other areas of the body
  • The prostate-specific antigen (PSA) level when the cancer is diagnosed
  • A measure of the likelihood that the cancer will rapidly grow and spread, known as the "grade group".

Most men with prostate cancer are diagnosed in one of the earlier stages, when it is treatable, and the overall prognosis at that point is good, compared with other types of cancer.

The stages of prostate cancer

The four stages of prostate cancer are numbered 1 to 4 (or sometimes using Roman numerals, I to IV), and some of these stages are further divided into sub-stages (A, B, C). In general, the higher the number, the more the cancer has spread.

Doctors use two different tests to determine stage: the PSA test and a digital rectal exam (DRE). Additional exams and tests are required to provide a definitive diagnosis, including a comprehensive physical exam, a biopsy of the prostate, an assessment of risk factors and diagnostic imaging tests.

Stage 1

There are three scenarios that will lead a doctor to diagnose a patient with stage 1 prostate cancer, according to the American Cancer Society:

  • Scenario 1: No tumor is detected on imaging tests such as an ultrasound. Instead, the tumor is discovered during a procedure called transurethral resection of the prostate (TURP) or is diagnosed through a needle biopsy.
  • Scenario 2: The doctor can feel the tumor via a digital rectal exam or see it in imaging tests. The tumor is on one-half of only one side of the prostate, or less.
  • Scenario 3: The tumor was in the prostate, but the prostate has already been removed through surgery.

Men diagnosed under any of these scenarios are in grade group 1 and have a PSA level lower than 10. In all cases, the cancer has not yet spread.

Stage 2

Stage 2 prostate cancer is further broken down into 2A, 2B and 2C.

2A: This sub-stage has two scenarios:

  • Scenario 1: The doctor can feel the tumor with a digital rectal exam or see it on an imaging test. Either the tumor is on one-half of only one side of the prostate, or less, or the prostate has already been removed through surgery and at that time the tumor had not spread beyond the prostate. Men diagnosed under this scenario are in grade group 1 and have a PSA level of at least 10 but lower than 20.
  • Scenario 2: The doctor can feel the tumor via a digital rectal exam or see it on an imaging test. The tumor is on more than half of one side of the prostate or on both sides. The cancer has not spread to the lymph nodes or any other area of the body. Men diagnosed under this scenario are in grade group 1 and have a PSA level lower than 20.

2B: The doctor may or may not be able to feel the tumor via a digital rectal exam or see it on an imaging test. The cancer has not spread to the lymph nodes or any other area of the body. Men diagnosed under this scenario are in grade group 2 and have a PSA level lower than 20.

2C: The doctor may or may not be able to feel the tumor with a digital rectal exam or see it on an imaging test. The cancer has not spread to the lymph nodes or other areas of the body. Men diagnosed under this scenario are in grade group 3 or 4 and have a PSA level lower than 20.

Stage 3

Stage 3 prostate cancer is further broken down into 3A, 3B and 3C.

3A: The doctor may or may not be able to feel or see the tumor. The cancer has not spread. Men diagnosed under this scenario are in grade group 1 to 4 and have a PSA level of at least 20.

3B: The cancer has spread beyond the prostate, possibly to the seminal vesicles or into other tissues adjacent to the prostate, such as the rectum, bladder, pelvis wall or the urethral sphincter (a muscle that helps control urination). The cancer has not spread to the lymph nodes or any other area of the body. Men diagnosed under this scenario are in grade group 1 to 4 and can have any PSA level.

3C: The cancer may or may not be in the process of growing beyond the prostate and into adjacent tissues. It has not spread to the lymph nodes or any other area of the body. Men diagnosed under this scenario are in grade group 5 and can have any PSA level.

Stage 4

Stage 4 prostate cancer is further broken down into 4A and 4B.

4A: The cancer may be in the process of growing beyond the prostate and into adjacent tissues. It has spread to the lymph nodes but has not spread to other areas of the body. Men diagnosed under this scenario can have any grade group and PSA value.

4B: The cancer may be in the process of growing beyond the prostate and into adjacent tissues and may have spread to the lymph nodes. It has spread to other areas of the body. Men diagnosed under this scenario can have any grade group and PSA value.

Treatment, Prognosis and Life Expectancy for Prostate Cancer

Treatment for prostate cancer varies widely, based on the stage of the patient’s disease and his health and ability to handle potential side effects of treatment. Treatment options include hormone therapy, immunotherapy, radiation therapy, chemotherapy and, if the disease has progressed to a late stage, palliative care.

The earlier prostate cancer is discovered, the higher the likelihood that treatment will be successful and the patient will be free of disease moving forward, according to Johns Hopkins Medicine. The good news is that the overall prognosis for prostate cancer is among the best of all cancers. However, the prognosis will depend on numerous individual factors.

Once a cancer that begins in the prostate spreads beyond the prostate, it is considered to be advanced, and there are no treatments that can cure the cancer at this stage, according to UCLA Health. There are, however, ways to help reduce the rate at which it spreads, extend life and control the symptoms. Your medical team will advise you based on your own unique circumstances and the specifics of your cancer.

Most prostate cancers — 90 percent — are discovered at a local or regional stage, and the five-year survival rate for these cases is nearly 100 percent, according to the American Cancer Society. The five-year survival for prostate cancer diagnosed at a late stage is 30 percent. The 10-year survival rate for all stages combined is 98 percent.