Understand What Your
Prostate Cancer Stage
Means for Treatment
The stage of your prostate cancer isn’t a result of one factor. Multiple tests are required to evaluate the aggressiveness of the cancer in your cells and the how far it has spread. Some of these tests include a Digital Rectal Exam (DRE), blood tests, imaging studies (e.g.: bone scans, MRIs, CT scans and trans-rectal ultrasounds) and biopsy results. Before you choose a treatment plan, it’s beneficial to familiarize yourself with how your stage is assigned, why it can influence your treatment decisions and what it means for the future.
Determining the Stage of Your Prostate Cancer
Using the results of your tests, your doctor will calculate a score based on four main components. Namely your: 1) PSA level, 2) Gleason score (tumor grade), 3) T-stage (tumor stage) and 4) whether the cancer has metastasized. The information below breaks down each component so you have a better understanding of what your results mean and where they land in the spectrum of cancer prognoses.
Your PSA Level
A prostate-specific antigen (PSA) blood test is usually one of the first steps doctors take in screening for prostate cancer. PSA is a protein produced by the prostate and usually found in semen and in trace amounts released in the bloodstream. While not a guarantee of prostate cancer, PSA levels tend to rise when there’s an issue with the prostate.
Classification of PSA Levels
|< 2.5||Based on your age and other risk factors, may only need to get retested every two years|
|> 2.5||Annual screening commonly recommended|
|4-10||One in four chance of being diagnosed with prostate cancer|
|> 10||Chance of a prostate cancer diagnosis rises to over 50%|
|>20||Advanced prostate cancer in many cases|
Grading Your Tumor Cells
Grading takes place post-biopsy to classify the aggressiveness of the cancer in your prostate cells. Your pathologist will study your tissue samples to identify cell patterns and amount of cellular deviation from normal prostate cells. He or she will then assign two separate grades to the two most predominant cancer cell patterns present in your tissue samples. Each cell pattern receives a grade between 1 and 5 based on the criteria below.
Grades of Prostate Cancer Cells
Grade 1 Small, uniform cells packed together that resemble normal prostate cells
Grade 2* Loosely packed cells of various shapes
Grade 3* Additional irregularities in cell size and shape, including cellular fusion
Grade 4* Large, abnormal cells fused together
Grade 5 Large, irregular cells fused together and starting to invade surrounding connective tissue
*Patterns of cells in these grades vary greatly as some cells look like normal prostate cells and others do not.
Calculating Your Gleason Score
Your Gleason score (scale from 2 to 10) is the sum of your most predominant cancer cell grade and your second-most predominant cancer cell grade. This score is not a direct indicator of the stage of your cancer. Rather, your Gleason score measures the risk and likelihood of the cancer spreading and growing.
Gleason Score Prostate Cancer Diagnosis
|Low Risk||Medium Risk||High Risk|
|Gleason Scores 2–5||Gleason Scores 6–7||Gleason Scores 8–10|
|Early-stage tumor and unlikely to grow or spread to other tissues or organs for many years. Many men choose to monitor their prostate cancer through active surveillance and regular checkups.||This group includes most prostate cancers. Typically, the cancer is unlikely to spread or grow for several years, but treatment may be recommended based on health, age and personal preferences.||More advanced tumor and at high risk of aggressively spreading. These cancer cells can also be “poorly differentiated,” meaning they may be early-stage if the cancer has not spread but is likely to within a few years.|
This stage is termed the T-stage to distinguish it as the stage of your tumor and not of your cancer. It’s calculated based on the size and extent the primary tumor has spread in and outside of your prostate.
T1/Stage A: Microscopic, non-palpable cancer tumor in one side of the prostate. It’s too small for your doctor to see or feel and can only be detected via imaging.
T2/Stage B: Confined in one or both sides of the prostate gland. Tumor has not spread outside of the gland but can be felt during a DRE.
T3/Stage C: Tumor has penetrated one or more sides of the prostate border.
T3b: Tumor has begun to grow in the seminal vesicles.
T4/Stage D: Tumor has advanced to neighboring structures and has begun to grow in the bladder, rectum and/or pelvic wall.
Extent Your Cancer Has Spread
If your cancer has spread outside of your prostate (T3/Stage C, T3b or T4/Stage D), there are two category measures to consider. These two measurements are commonly combined with your T-stage to form one TMN score.
N-Category: Determines if and how far the cancer has spread to your lymph nodes.
M-Category: Determines if and how far the cancer has metastasized or spread to other organs.
Prostate Cancer Stages Based on Standard Scores
After calculating the TNM categories, your doctors will combine your TNM score, Gleason score and PSA levels to assign of a specific stage to your prostate cancer. Keep in mind that every case is different, and statistics and other recommendations are purely general guidelines.
|Stage 1||Stage 2||Stage 3||Stage 4|
|Low Risk||Favorable Intermediate Risk||Unfavorable Intermediate Risk||High Risk|
|PSA: <10||PSA: 10–20||PSA: 10–20||PSA: >20|
|Gleason Score: <6||Gleason Score: 6–7||Gleason Score: 6–7||Gleason Score: 8–10|
|T-Stage/TMN Score: T1 or T2a||Stage/TMN Score: T2||Stage/TMN Score: T3 or T3b||T-Stage/TMN Score: T4 (likely category N and/or M)|
Prostate Cancer Survival Rates
In general, prostate cancer has a very high survival rate—one of the highest among all types of cancer—because prostate cancer is often a slow-moving disease. Recent studies further support that the chances of survival increase as treatments continue to improve.
Relative Prostate Cancer Survival Rates*
|5 years||10 years||15 years|
*Percentages factor in all stages of prostate cancer. Relative survival rate means the percentage of patients who live x number of years after their initial diagnoses, not after stoppage of treatment.
Prostate Cancer Stages and Possible Treatment Options
Stage 1 Prostate Cancer Treatment
Prostate cancer is found in the prostate gland only and is non-detectable by an imaging test or DRE physical examination. Older men, men who suffer other serious health issues or younger men may consider active surveillance due to the slow growth rate, possibility of never experiencing any symptoms or preference to delay treatment. However, radiation or proton therapy for stage 1 prostate cancer is often recommended to reduce the risk of cancer spreading, especially for those with higher Gleason scores and PSA levels. Almost 80% of the time, prostate cancer is discovered at this stage and the 5-year survival rate is nearly 100%.
Stage 2 Prostate Cancer Treatment
Prostate cancer is more advanced than in stage 1 but has not spread outside the prostate. However, the cells have a higher Gleason score and are more likely to grow at a quicker rate. With stage 2 prostate cancer, surgery, hormone therapy and radiation or proton therapy are treatment options to further reduce the risk of cancer spreading or returning. Active surveillance still may be recommended for older men or those with other serious health issues. Similar to local stage prostate cancers, the 5-year survival rate is nearly 100%.
Stage 3 Prostate Cancer Treatment
Prostate cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. Tumor has not reached bladder, rectum, lymph nodes or distant organs. Surgery and radiation or proton therapy with hormonal therapy are the curative treatment options with stage 3 prostate cancer. Radiation or proton therapy may still be needed after surgery to provide additional local and distant cancer control. Active surveillance may still be recommended for older men or those with other serious health issues. Similar to local stage prostate cancers, the 5-year survival rate is nearly 100%. That being said, the chances of prostate cancer coming back after treatment is more likely at this stage.
Stage 4 Prostate Cancer Treatment
This is the last stage of prostate cancer and describes a tumor that has spread beyond the seminal vesicles to nearby tissues or organs, such as the bladder, rectum, lymph nodes or bones. At this point, treatment of the whole body with hormonal therapy or systemic therapy is the mainstay of stage 4 prostate cancer treatment. Local therapy with surgery or radiation therapy may be needed to help control symptoms. Proton radiation treatment may be used for advanced or late-stage prostate cancer to shrink tumors or control pain. While treatment can only cure a small percentage of T4 tumors, treatment may still be recommended to prolong or improve quality of life. For these distant stage cancers, the 5-year survival rate is 29%.
Discussing Your Prostate Cancer Treatment Options
It’s important to discuss all of your treatment options with your doctor(s) to help you make a comfortable and appropriate decision. If time permits, it’s good to seek a second opinion to obtain more information and feel more confident in your treatment plan.
Some important things to consider include:
- Your short- and long-term goals
- The stage and grade of your cancer
- Your age and expected life span
- Other serious health issues
- Your need to treat the cancer right away
- The likelihood that treatment will cure your cancer (or help in some other way)
- Your feelings about the possible side effects from each treatment
Consider Choosing Proton Therapy Radiation
Proton therapy is gaining popularity for its ability to more precisely target tumors and reduce radiation damage to healthy tissues and surrounding organs. This treatment has also been shown to result in strong cure rates, reduced side effects and improved long-term outcomes, such as a lower risk of impotence and incontinence.