Prostate cancer

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Stages of prostate cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for prostate cancer is the TNM system. For prostate cancer there are 4 stages. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.

When describing the stage, doctors often use the words localized, locally advanced or metastatic.

Localized means that the cancer is only in the prostate. The cancer hasn’t grown into nearby tissues or to distant parts of the body. Localized prostate cancer includes stage 1 and stage 2.

Locally advanced means the prostate cancer has grown through the covering of the prostate (called the capsule) to nearby tissue. Localized prostate cancer includes stage 3 and stage 4 disease that hasn’t spread to distant parts of the body (metastasized).

Metastatic means the cancer has spread beyond the tissues surrounding the prostate to other parts of the body.

Doctors may also use the words local, regional or distant. Local means that the cancer is only in the prostate and has not spread to other parts of the body. Regional means close to the prostate or around it. Distant means in a part of the body farther from the prostate.

The following staging information is for adenocarcinoma, which makes up 95% of all prostate cancers. Other types of prostate cancer are staged differently. Urothelial carcinoma is a type of cancer that starts in cells that line the urethra, including the part that passes through the prostate (called the prostatic urethra). Urothelial carcinoma of the prostatic urethra is staged similar to renal pelvis and ureter cancer. Find out more about urothelial carcinoma and staging cancer of the renal pelvis and ureter.

TNM descriptions

T describes how much of the prostate contains cancer and if doctors can feel the cancer or see it on imaging tests. It also describes if the tumour has grown outside of the prostate to the surrounding tissues. T is usually given as a number from 1 to 4. A higher number means that the tumour takes up more of the prostate or that the tumour has grown outside of the prostate into nearby tissues.

 

N describes whether or not cancer has spread to lymph nodes near the prostate. N0 means the cancer hasn’t spread to any nearby lymph nodes. N1 means cancer has spread to nearby lymph nodes.

 

M describes whether or not the cancer has spread to other parts of the body. M0 means that cancer has not spread to other parts of the body. M1 means that it has spread to other parts of the body.

Find out more about staging cancer.

Stage 1 (T1 or T2a, N0, M0)

The cancer may have been found when tissue was removed from the prostate for another condition, such as benign prostatic hyperplasia. The cancer may also have been found by a needle biopsy.

OR

 

The tumour is in one lobe of the prostate and it takes up one-half or less of the lobe (T2a).

Stage 2 (T2b or T2c, N0, M0)

The tumour is in more than half of one lobe (T2b) or in both lobes (T2c) of the prostate.

Stage 3 (T3 or T4, N0, M0)

The tumour has grown through the capsule and either into the lower part of the bladder (called the bladder neck) or into one or both of the glands found above the prostate (called the seminal vesicles) (T3).

OR

 

The tumour has attached to or grown into any of the following (T4):

  • rectum
  • external sphincter of the anus
  • levator muscles of the pelvic floor
  • pelvic wall

Stage 4 (any T, N1, M0 or any T, N0, M1)

The cancer has spread to lymph nodes (N1) or other parts of the body (called distant metastasis) such as the bones (M1). Prostate cancer that has spread to distant parts of the body is called metastatic prostate cancer.

Recurrent prostate cancer

Recurrent prostate cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.

Recurrent prostate cancer is also diagnosed when the prostate-specific antigen (PSA) level starts to rise quickly after initial treatment but there are no other signs of cancer. This is called a biochemical recurrence of prostate cancer.

urethra

The tube that carries urine from the bladder to the outside of the body.

In males, the urethra passes through the prostate and penis and carries semen as well as urine. In females, the urethra opens above the vaginal opening.

benign prostatic hyperplasia

A non-cancerous (benign) enlargement of the prostate.

Also called benign prostatic hypertrophy.

pelvic floor

The muscles that make up the lower part of the pelvis. These muscles support the organs inside the pelvis. When pelvic floor muscles don’t work properly, it may cause incontinence.

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