Stages of Prostate Cancer

STAGING: AN IMPORTANT STEP IN CHOOSING THE RIGHT TREATMENT

Staging is the assessment of the size and location of prostate cancer (that is, determining if, and how far, the cancer has already spread). Staging is necessary for you and your physician to decide what type of treatment is most appropriate.6

Currently, two different systems are used to stage prostate cancer. The most commonly used staging system is called TNM, which stands for tumor-nodes-metastasis. The traditional method classifies the disease into four clinical categories rated A through D. Although TNM is the more accepted staging system, the A–D system is still used.6

TNM STAGING6

TNM staging uses tumor size (T) and whether the cancer has spread to lymph nodes (N) or metastasized to distant sites in the body (M) to determine a cancer’s stage.

Measuring the Extent of Cancer by TNM Stage11

 Tumor size (T) is assessed on a scale of 1 to 4

T1

Tumors graded T1 are found only in a prostate biopsy or prostatectomy specimen, and they are so small that they cannot be felt during a DRE or detected during an imaging test.

T1a

Less than 5% of the tissue removed is cancerous.

T1b

More than 5% of the tissue removed is cancerous.

T1c

Cancers found by biopsy that were taken because the patient had an elevated PSA level despite having a normal DRE.

T2

T2 prostate cancer is confined to the prostate, but it is large enough to be detected during a DRE.

T2a

Cancer is found only on the left OR right side of the prostate; only half or less of the affected side is cancerous.

T2b

Cancer is found only on the left OR right side of the prostate; more than half of the affected side is cancerous.

T2c

Cancer is found in both the left and right sides of the prostate.

T3

Cancer has spread beyond the outer rim that surrounds the prostate gland. The cancer has reached the connective tissue next to the prostate and/or the seminal vesicles. Read more about advanced prostate cancer.

T3a

Tumor grows outside the prostate, but the cancer has not spread to the seminal vesicles.

T3b

Cancer has spread to the seminal vesicles, and traces of cancer may also be present in the neck of the bladder.

T4

Tumor has spread to organs near the prostate such as the bladder or rectum.

 Lymph node involvement (N) is graded on a scale of X to 1

NX

Lymph nodes near the prostate gland were not tested for cancer.

N0

Cancer has not spread into the lymph nodes.

N1

Cancer has spread to the lymph nodes in the pelvis.

 Metastasis (M) is rated X to 1

MX

No tests were done to check for cancer
that may have spread to distant
places in the body.

M0

Cancer has not spread.

M1

Cancer has spread to a distant location, such as the spinal column.

M1a

Cancer has spread to distant lymph nodes.

M1b

Cancer has spread to the bone.

M1c

Cancer has spread to other organs such as the lungs, liver, or brain.

A–D STAGING6

Stage A
Early cancer. The tumor is located within the prostate gland and cannot be detected by a digital rectal exam (DRE).

Stage B
Tumor is considered to be within the prostate but is large enough to be felt during a DRE.

Stage C
Prostate cancer is more advanced. The tumor has spread outside the prostate to some surrounding areas but has not spread to other organs. This stage of prostate cancer can usually be detected by a DRE.

Stage D
Cancer has spread to the nearby organs and usually to distant sites, such as the bones or lymph nodes.

Read more about advanced prostate cancer.