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What are the different stages of prostate cancer?

Stage refers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the prostate gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland and may be in the seminal vesicles. Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to other tissues or organs.

This answer is based on source information from the U.S National Institutes of Health.

Dr. Robert E. Reiter, MD
Urologist

Prostate cancer progresses from early organ-confined disease to metastatic disease. Stage 1 and stage 2 prostate cancer indicate that the cancer is confined to the prostate itself. Stage 3 and 4 prostate cancer imply progression outside of the prostate gland into surrounding tissues. Metastasis to lymph nodes, soft tissues or bone is categorized as well.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

The following are the stages of prostate cancer:

  • Stage 1: Tumor in one half lobe of prostate
  • Stage 2: Similar mass; prostate-specific antigen (PSA) higher; cell changes
  • Stage 3: Tumor spreads outside prostate
  • Stage 4: Disease spreads to nearby organs

This content originally appeared on doctoroz.com.

Stages of prostate cancer run from:

  • Stage 1 — Confined to the prostate and usually found due to an elevated prostate-specific antigen (PSA) test
  • Stage 2 — Abnormal rectal exam confined to the prostate
  • Stage 3 — Outside of prostate but limited to the area around the prostate
  • Stage 4 — Into other organs or widespread

Typically, we think stages 1 and 2 have a good likelihood of cure, stage 3 can sometimes be cured and stage 4 can be treated successfully but is unlikely to be cured.

Prostate cancer stages are clearly identifiable. Your doctor will examine the cancer tissues to determine the stage of the disease. 

  • Stage I: Cancer is confined to the prostate. It can’t be detected during a digital rectal exam (DRE). It is usually expected to be slow growing.
  • Stage II: Cancer can be detected during a DRE. It’s still confined to the prostate, but the cells may be more abnormal and may grow faster.
  • Stage III: Cancer is in tissues near the prostate. It also may have reached the seminal vesicles.
  • Stage IV: Cancer has invaded other parts of the body, such as the rectum, nearby lymph nodes or bone.
  • Recurrent: Cancer has returned after treatment. It may recur in the prostate area or in other places, such as the bones.

Stage I: The cancer is found only in the prostate. The tumor cannot be felt during a digital rectal exam (DRE) and does not show up with any imaging technology.

Stage IIA: The tumor has grown within the prostate but has not spread outside of the prostate. It can be felt in one half of one side of the prostate.

Stage IIB: The tumor has grown within the prostate but has not spread outside of the prostate. It can be felt on the top or bottom half of the prostate.

Stage IIC: The tumor has grown within the prostate but has not spread outside of the prostate. Abnormalities can be felt in both sides of the prostate.

Stage III: Cancer has spread beyond the capsule of the prostate into the area immediately beyond the capsule.

Stage IV: Cancer has metastasized, or spread, beyond the prostate to other areas like the bladder, rectum, lymph nodes and bones. This stage of prostate cancer is not usually considered curable.

Dr. Marc B. Garnick, MD
Hematologist & Oncologist

The prognosis and decisions about treatment for prostate cancer depend on staging. A staging system is a common way of describing how far the cancer has progressed. There are different staging systems for prostate cancer, but the most widely used one is the tumor-node-metastasis (TNM) system, short for tumor-node-metastasis. It describes the extent of the primary tumor, whether the cancer has spread to nearby lymph nodes, and whether it has spread to distant sites.

These are the stages of prostate cancer:

Stage T1: Your doctor can't feel these tumors during a digital rectal examination (DRE) or see them with an imaging test such as a transrectal ultrasound.

  • T1a: Tumor is found incidentally during treatment for benign prostatic hyperplasia (BPH)—enlarged prostate; less than 5 percent of the tissue removed is cancerous.
  • T1b: Like T1a, but more than 5 percent of the tissue removed is cancerous.
  • T1c: Detected when an elevated prostate-specific antigen (PSA) —a protein produced by the prostate—leads to a needle biopsy.

Stage T2: These cancers can be felt during a DRE and seem confined to the prostate.

  • T2a: The cancer fills less than half of one side (left or right) of the prostate.
  • T2b: Like T2a, but the cancer fills more than half of one side (left or right) of the prostate.
  • T2c: Like T2a, but cancer is detected in both sides (left and right) of the prostate.

Stage T3: These cancers have broken through the prostate's fibrous capsule.

  • T3a: The cancer extends outside the prostate but has not spread to the seminal vesicles.
  • T3b: The cancer has spread to the seminal vesicles.

Stage T4: Like T3 disease, but the cancer invades other nearby structures, such as the rectum or the muscle that helps control urination.

Stages N and M: These cancers have metastasized to the pelvic lymph nodes (N1) or to other parts of the body (M1). Cancers that have spread to distant lymph nodes are classified as M1a, while cancers that have spread to the bones are M1b. Cancers that have spread to other sites, such as the lungs, but not the bones, are classified as M1c.

 

There are two different types of prostate cancer staging: clinical and pathologic. Clinical stage refers to the approximation of cancer at diagnosis and is based on digital rectal exam (DRE), lab tests, biopsy and imaging. Pathologic stage refers to staging after the prostate has been removed and is considered more accurate. This is just one advantage of undergoing prostatectomy (surgical removal of the prostate) compared to other modalities.

The most common staging system for prostate cancer is the American Joint Committee on Cancer (AJCC) TNM system. It is based on five critical aspects: 1- extent of primary tumor (T), 2- has the cancer spread to lymph nodes (N), 3- absence or presence of distance metastasis (M), 4- PSA at diagnosis and 5- Gleason score.

Clinical stages of prostate cancer include:

  • T1: A tumor that is neither palpable via DRE nor visible via imaging
  • T1a: Tumor is found incidentally in ≤5% of tissue (i.e. after a transurethral resection of the prostate [TURP])
  • T1b: Tumor is found incidentally in >5% of tissue
  • T1c: Tumor identified by needle biopsy done because of increased PSA
  • T2: Tumor is confined to the prostate and is palpable via DRE and/or visible via imaging
  • T2a: Tumor involves ≤ ½ of one (left or right) lobe
  • T2b: Tumor involves more than ½ of one lobe, but not both lobes
  • T2c: Tumor involves both lobes
  • T3: Tumor has spread beyond prostate capsule
  • T3a: Tumor extends outside the prostate but not into seminal vesicles
  • T3b: Tumor invades the seminal vesicle(s)
  • T4: Tumor invades adjacent structures (other than seminal vesicles) including bladder, urethral sphincter, rectum and/or pelvic wall

Pathologic stages include:

  • pT2: Tumor confined to prostate
  • pT2a: Tumor involves ½ of lobe or less
  • pT2b: Tumor involves more than ½ of one lobe, but not both lobes
  • pT2c: Tumor involves both lobes
  • pT3: Tumor extends beyond prostate capsule
  • pT3a: Extraprostatic extension or microscopic invasion of bladder neck
  • pT3b: Tumor invades the seminal vesicle(s)
  • pT4: Tumor invades rectum, levator muscles and/or pelvic wall 

N: Lymph node involvement:

  • Nx: Adjacent lymph nodes were not assessed
  • N0: Cancer has not spread to adjacent lymph nodes
  • N1: Cancer has spread to one or more pelvic lymph nodes

M: Metastases (presence or absence):

  • M0: Cancer has not spread past adjacent lymph nodes
  • M1: Cancer has spread beyond pelvic lymph nodes
  • M1a: Cancer has spread to distant lymph nodes (outside the pelvis)
  • M1b: Cancer has spread to bones
  • M1c: Cancer has spread to other organs (i.e. lungs, liver, brain)

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.