After a prostate cancer diagnosis, your oncologist will need to stage your cancer. Staging helps determine how advanced the cancer is and whether it has spread. The cancer care team will use this information to create a treatment plan that provides you with the best possible outcome. 

How Is Prostate Cancer Staged? 

Doctors consider several factors when assigning a stage to your cancer. The pathology report provides some key pieces of information. This data, combined with recent imaging tests and PSA blood test results, determines the stage and guides the treatment planning process.

TNM Staging System

The most commonly used staging system for prostate cancer is the AJCC (American Joint Committee on Cancer) TNM system, which is based on the following information:

• Tumor size (T): This is categorized as either clinical (cT) or pathological (pT)
• Lymph node involvement (N): Whether the cancer has spread to nearby lymph nodes
• Metastasis (M): This indicates whether the cancer has spread to other parts of the body

For prostate cancer, additional data is used to determine whether you should start treatment right away. Your prostate cancer doctor will also factor in your PSA level at the time of diagnosis and the Grade Group, which is based on the Gleason score of your tumor. The Gleason score is found in the pathology report.

Related Reading: What You Should Know About Your Prostate Pathology Report

Gleason Score and Grade Groups

Once the Gleason score is determined, a grade group is assigned. Five grades of prostate cancer are associated with the Gleason score. Higher grades indicate more aggressive cancer that is likely to grow and spread quickly, while lower scores represent slower-growing cancer that may not need treatment immediately.

PSA Levels

While an elevated PSA level is not the sole factor for diagnosing prostate cancer, it does give your oncologist an indication of how much cancer is present. In prostate cancer staging, PSA can be categorized as medium (greater than 10 but less than 20) or high (above 20) for stages 1 through 3. In stage 4 prostate cancer, PSA levels have less impact on the recommended treatment plan because the cancer has already spread beyond the prostate.

The Stages of Prostate Cancer

Prostate cancer is classified from stage I (1) to stage IV (4), with stage I marking the earliest phase of the disease and stage IV indicating the most advanced level of spread.

• Stage I prostate cancer is confined to the prostate gland. At this stage, both the PSA levels and Gleason score are low. The tumor is slow-growing and may not require immediate treatment.
  • Grade Group 1, Gleason score less than 6, PSA less than 10
• Stage II cancer affects a larger area of the prostate compared to stage I, which typically means higher PSA levels and/or a higher Gleason score. At this stage, cancer has not affected the lymph nodes. You may or may not need active treatment depending on your risk group, which determines how likely the cancer is to spread.
  • Stage IIA: Grade Group 1, Gleason score 6 or less, PSA at least 10 but less than 20
  • Stage IIB: Grade Group 2, Gleason score 7, PSA less than 20
  • Stage IIC: Grade Group 3, Gleason score 7 or 8, PSA less than 20
• Stage III indicates that the cancer has spread beyond the prostate to nearby tissues but not into the lymph nodes. Because of the risk of further spread, immediate treatment is necessary, which often includes radiation, hormone therapy, or surgery.
  • Stage IIIA: Grade Group 1 to 4, Gleason score 8 or less, PSA at least 20
  • Stage IIIB: Grade Group 1 to 4, Gleason score 8 or less, any PSA
  • Stage IIIC: Grade Group 4, Gleason score 9 or 10, any PSA
• Stage IV prostate cancer has spread to lymph nodes, bones, or other organs. This is also called advanced or metastatic prostate cancer. Treatment focuses on managing symptoms and slowing the cancer's growth. It may not be possible to surgically remove all of the cancer cells for stage IV patients. However, extensive research is being done and new treatments are now available for metastatic prostate cancer.
  • Stages IVA and IVB: Any Grade Group and any PSA

Learn more about the stages of prostate cancer. 

How Staging Impacts Your Prostate Cancer Treatment Plan

If you are diagnosed with early-stage prostate cancer that appears to be growing slowly, your doctor may recommend active surveillance. By choosing active surveillance, you can delay surgery and radiation treatment, along with their associated side effects, until the cancer has started to grow further. 

Related Reading: Should You Wait Before Starting Prostate Cancer Treatment?

Men who need immediate treatment or decide to skip active surveillance may opt for one or more treatment options, including surgery, radiation therapy, and hormone therapy. In cases where hormone therapy has been unsuccessful, chemotherapy may be used. 

Doctors typically manage advanced (metastatic) prostate cancer with hormone therapy. However, over time, this treatment may become less effective. If this occurs, your doctor may recommend chemotherapy or other experimental treatments currently being studied. 

For those diagnosed with a specific type of advanced prostate cancer known as metastatic castration-resistant prostate cancer (mCRPC), there is a promising targeted therapy called Pluvicto™. This radiopharmaceutical treatment delivers radiation directly to prostate cancer cells, effectively destroying them while preserving healthy surrounding tissue.

Learn more about available prostate cancer treatment options. 

Prostate Cancer Prognosis and Survival Rates By Stage

As with most cancers, early detection of prostate cancer is crucial for a positive outcome. The good news is that prostate cancer generally has one of the best prognoses because it tends to be slow-growing and multiple treatments are available.

According to the American Cancer Society, most men diagnosed with local or regional cancer (stages I, II, and III) can expect to be disease-free after five years. In contrast, prostate cancers diagnosed at the distant stage (stage IV) have an average five-year survival rate of 37 percent.

It's important to understand that the prognosis for prostate cancer varies due to many personal factors. Survival rates and likelihood of recurrence differ among individuals. Your doctor can provide a more accurate outlook based on your specific situation.

Questions to Ask Your Doctor About Your Prostate Cancer Stage

If you've been diagnosed with prostate cancer, it is important to have open and honest discussions with your cancer care team. Some questions you might want to ask might include:

• Can my stage of prostate cancer be cured?
• What symptoms could I experience based on my stage of cancer?
• What is my risk group?
• Am I eligible for any clinical trials?
• What are the chances of recurrence, and what would our next steps be if this occurs? 

Personalized Prostate Cancer Care in Colorado

If you or a loved one was recently diagnosed with prostate cancer, the prostate cancer doctors at Rocky Mountain Cancer Centers are here to provide guidance and develop a personalized treatment plan.

Prostate cancer specialists are available at RMCC locations throughout Colorado, including Boulder, Colorado Springs, Denver, and surrounding towns. It’s helpful to request a consultation after a diagnosis, before your urologist performs surgery, to see if other options are available. Read more about this in our blog: Does Surgery Have to Be Part of Prostate Cancer Treatment?