Prostate Cancer Stages are the way of describing where cancer spreads and whether it affects other parts of the body.
Doctors use diagnostic tests to find out the stage of cancer, so the staging may not be complete until all tests are completed. The staging of prostate cancer also includes reviewing the test results to determine.
If cancer has spread from the prostate to other parts of the body. Understanding this phase will help doctors decide which treatment is best and help predict the patient’s prognosis, which is an opportunity for recovery. There are different stages of a description of different types of cancer.
There are two types of stages of prostate cancer:
This is based on the results of the DRE, PSA test and Gleason score (see “Gleason score prostate cancer score” below). These test results will help determine if X-rays, bone scans, CT scans or MRI are still needed. If they need to scan, they can add more information to help the doctor find the clinical stage.
This is based on information found during surgery and laboratory results (called pathology) of prostate tissue removed during surgery. Surgery usually involves resection of the entire prostate and some lymph nodes. Checking for removed lymph nodes can provide more information for pathological staging.
TNM Staging System:
One tool that doctors use to describe the stage is the TNM staging system. The doctor uses the results of the diagnostic tests and scans to answer the following questions:
A tumor (T):
How big is the primary tumor? where is it?
Does the tumor spread to the lymph nodes? If so, where and how much?
Does cancer metastasize to other parts of the body? If so, where and how much?
The results are combined to determine the cancer stage of each person. There are five phases: phase 0 (zero) and phase I to IV (1 to 4). This phase provides a common method of describing cancer so doctors can work together to plan the best treatment.
Below are more details about the various parts of the prostate cancer TNM system.
A tumor (T):
Using the TNM system, “T” plus letters or numbers (0 to 4) are used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help to describe the tumor in more detail. The specific tumor staging information is as follows. If the tumor is clinically staged, it is usually written as CT. If pathological staging is used, it is written as pT.
Unable to assess primary tumor.
T0 (T plus zero):
No evidence of prostate tumors.
No tumor was felt during DRE and no tumor was seen during the imaging test. When surgery is performed for other reasons, it may be found that abnormal growth of BPH or non-cancer prostate cells are usually present.
- T1a: 5% or less of prostate tissue removed by the tumor during surgery.
- T1b: Tumors accounted for more than 5% of prostate tissue during surgery.
- T1c: Tumors are found during a needle biopsy, usually because of elevated PSA levels in patients.
Tumors are only found in the prostate, not in other parts of the body. It is big enough to be felt during the DRE.
- T2a: The tumor involves half of the prostate 1 side.
- T2b: The tumor involves more than half of the prostate 1 side but not both sides.
- T2c: The tumor has grown into both sides of the prostate.
The tumor has grown through the prostate 1 side and entered the tissue outside the prostate.
- T3a: The tumor grows through the prostate on one or both sides of the prostate. This is called extraprostatic extracorporeal expansion (EPE).
- T3b: The tumor has grown into a seminal vesicle, a tube that carries semen.
The tumor is fixed, or it is growing to a nearby structure other than the seminal vesicle, such as the external sphincter, part of the muscle layer, which helps control urination; rectum; bladder; levator muscle; or pelvic wall.
The “N” in the TNM staging system represents a lymph node. These tiny bean-shaped organs help fight infections. The lymph nodes near the prostate in the pelvic area are called regional lymph nodes. Lymph nodes in other parts of the body are called distal lymph nodes.
Unable to assess regional lymph nodes.
N0 (N plus zero):
Cancer has not spread to regional lymph nodes.
Cancer has spread to the regional (pelvic) lymph nodes.
The “M” in the TNM system indicates whether prostate cancer has spread to other parts of the body, such as the lungs or bones. This is called a distant transfer.
Unable to assess distant Metastasis.
M0 (M plus zero):
The disease has not been Metastasized.
There is a distant Metastasis.
M1a: Cancer has spread to non-regional or distal lymph nodes.
M1b: Cancer has spread to bones.
M1c: Cancer spreads to another part of the body, with or without spreading to the bones.
Gleason Score For Prostate Cancer Grading:
Prostate cancer is also known as the Gleason score. This score is based on the extent to which cancer looks like healthy tissue when viewed under a microscope. Invasive tumors usually look more like healthy tissue. More aggressive tumors may grow and spread to other parts of the body. They don’t look like healthy organizations.
The Gleason scoring system is the most commonly used prostate cancer grading system. Pathologists study how cancer cells line up in the prostate and assign 3 to 5 points from 2 different locations. Cancer cells that look similar to healthy cells have lower scores.
It doesn’t look like healthy cells or cancer cells that look more aggressive get higher scores. To assign numbers, pathologists determine the main pattern of cell growth, the most visible area of cancer and look for another growing area. The doctor then gives each area a score from 3 to 5. The scores add up to a total score between 6 and 10.
Do not use Gleason scores of 5 or lower. Gleason scored a minimum of 6 points, which is a low-grade malignant tumor. The Gleason score is 7 for moderate cancer, with a score of 8 and 9 or 10 for high-grade cancer. Low-grade cancers grow at a slower rate and are less likely to spread than high-grade cancers.
In addition to helping with the planned treatment phase, doctors will also look at the Gleason score. For example, for patients with small tumors, low PSA levels, and a Gleason score of 6, active monitoring (see treatment options) may be an option. Patients with higher Gleason scores may require more intensive treatment, even if the cancer is not large or diffuse.
Gleason score is not certain.
Gleason 6 or lower:
Cells differentiate well, which means they look similar to healthy cells.
Cells are moderately differentiated, which means they look a bit like healthy cells.
Gleason 8, 9 or 10:
Cells are poorly differentiated or undifferentiated, which means they look very different from healthy cells.
Gleason scores are usually divided into simplified grade groups:
1st grade = Gleason 6
Rank Group 2 = Gleason 3 + 4 = 7
Rank Group 3 = Gleason 4 + 3 = 7
Gleason Group 4 = Gleason 8
Gleason Group 5 = Gleason 9 or 10
Cancer Stage Grouping:
The doctor specifies the stages of cancer by combining the T, N, and M classifications. The staging also includes the PSA level (see Screening) and the grade group.
Cancer at this early stage usually grows slowly. Tumors cannot be felt and involve half or less of the prostate 1 side. The PSA level is very low. Cancer cells differentiate well, meaning that they look like healthy cells (cT1a–cT1c or cT2a or pT2, N0, M0, PSA levels less than 10, grade group 1).
Tumors are only found in the prostate. The PSA level is medium or low. Stage II prostate cancer is small, but there may be a risk of increased and spread.
Stage 2A: The tumor cannot be felt and involves half or even less of the prostate 1 side. PSA levels were moderate and cancer cells differentiated well (cT1a-cT1c or cT2a, N0, M0, PSA levels between 10 and 20, grade group 1). As long as the cancer cells are still well-differentiated (cT2b-cT2c, N0, M0, PSA levels less than 20, Group 1), this stage also includes larger tumors confined to the prostate.
Stage 2B: Tumors are only found in the prostate and may be large enough to be felt during DRE. The PSA level is moderate. Cancer cells are moderately differentiated (T1-T2, N0, M0, PSA levels below 20, grade 2).
Stage 2C: Tumors are only found inside the prostate and may be large enough to be felt during DRE. The PSA level is moderate. Cancer cells can be moderately or poorly differentiated (T1-T2, N0, M0, PSA levels less than 20, grades 3-4).
High PSA levels, tumors are growing, or cancer is high. These all indicate locally advanced cancer that may develop and spread.
Stage 3A: Cancer has spread to the outer layer of the prostate to nearby tissues. It may also have spread to the seminal vesicle. The level of PSA is very high. (T1-T2, N0, M0, PSA level is 20 or higher, rank group 1-4).
Stage 3B: Tumors grow outside the prostate and may invade nearby structures such as the bladder or rectum (T3-T4, N0, M0, any PSA, grades 1-4).
Stage 3C: The cancer cells of the entire tumor are poorly differentiated, which means that they look very different from healthy cells (any T, N0, M0, any PSA, grade group 5).
Cancer has spread beyond the prostate.
Stage 4A: Cancer has spread to regional lymph nodes (any T, N1, M0, any PSA, any grade group).
Stage 4B: Cancer has spread to distant lymph nodes, other parts of the body or bones (any T, N0, M1, any PSA, any grade group).
Recurrent prostate cancer is cancer that recurs after treatment. It may appear again in the prostate area or other parts of the body. If cancer does recur, there will be another round of testing to understand the extent of the recurrence. These tests and scans are usually similar to the tests and scans at the time of the original diagnosis.
Licensed by the American College of Surgeons, Chicago, Illinois. The original and primary source of this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.
Prostate Cancer Risk Group:
In addition to the stage, doctors use other prognostic factors to help plan the best treatment and predict the success of the treatment. Two such risk assessment methods come from the National Integrated Cancer Network (NCCN) and the University of California, San Francisco (UCSF).
The NCCN developed four risk group categories based on PSA levels, prostate size, needle biopsy results, and cancer staging. The lower the risk, the lower the likelihood that prostate cancer will grow and spread.
Very low risk:
Tumors were not felt during DRE and no tumors were seen during the imaging test but were found during needle biopsy (T1c). PSA is less than 10 ng / mL. Gleason scored 6 or lower. Cancer was found in fewer than 3 samples during the core biopsy. Cancer is found in half or less of any core.
Tumors are classified as T1a, T1b, T1c or T2a (see above). PSA is less than 10 ng / mL. Gleason scored 6 or lower.
Tumors have two or more of the following characteristics:
- Classified as T2b or T2c (see above)
- PSA is 10 to 20 ng / mL
- Gleason scored 7 points
Tumors have two or more of the following characteristics:
- Classified as T3a (see above)
- PSA levels above 20 ng / mL
- Gleason scored between 8 and 10
Source: Risk group information is adapted from NCCN.
University of California, San Francisco, Prostate Cancer Risk Assessment (UCSF-CAPRA) score:
The UCSF-CAPRA score predicts the likelihood and mortality of men with cancer. This score can be used to help make decisions about prostate cancer treatment plans. The score is assigned based on the patient’s age at diagnosis, the level of PSA at the time of diagnosis, the Gleason score of the biopsy, the T-class of the TNM system, and the percentage of cancer-associated biopsy cores. Then use these categories to specify a score between 0 and 10.
- A CAPRA score of 0 to 2 indicates low risk.
- A CAPRA score of 3 to 5 indicates intermediate risk.
- A CAPRA score of 6 to 10 indicates a high risk.