A  A  A
Prostate Cancer: Grade and Stage

Prostate Cancer: Grade and Stage

Once your health care provider knows you have cancer, the next step is to find out the grade and stage of the cancer. Grade is a way to note how abnormal the cancer cells look under a microscope. Staging of cancer is a method of noting the extent of the cancer. The stage tells how big the cancer is, and if it has spread. Grade and stage are determined when a biopsy (tissue sample) and other tests are done on the cancer. Staging and grading of cancer is important for deciding how to treat it, and how curable it is.

Grades of prostate cancer

The grade refers to how the cancer cells look when compared to normal prostate cells. The grade of your cancer will help your health care provider predict how fast the cancer may grow and spread.

The Gleason scale of 2 to 10 is used to grade prostate cancer. The lower the number, the more the cancer cells look like normal cells. This means the cancer can be easier to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Higher grades of cancer look very different from normal prostate cells. These grades of cancer are harder to treat. Most prostate cancers are graded at least 6. Prostate cancers with low scores are less likely to spread to other organs than those with high scores.

Stages of prostate cancer

The stage of your cancer describes the size of a tumor, and how much it has spread. Health care providers use different rating systems to stage cancer. The American Joint Committee on Cancer (AJCC) staging system is used most often for prostate cancer. It’s called the TNM system:

  • T stands for tumor. This category notes the size of the tumor and if it has spread into nearby areas.

  • N stands for nodes. Lymph nodes are small organs around the body. They help the body fight infections. This category notes if cancer cells have spread to the nearby lymph nodes.

  • M stands for metastasis. This category notes if the cancer has spread to otherorgans in the body. This may include a lung, your bones, liver, or brain. It also includes lymph nodes that are not near your kidneys.

Numbers from 0 to 4 are assigned to the T, N, and M categories. Once your health care provider has determined your T, N, and M values, he or she then determines your stage grouping. The lower numbers mean smaller cancers and that are easier to treat and cure.

There are 2 types of stages for prostate cancer:

  • Clinical stage. This measurement helps your health care provider decide on the best treatment options for you. For prostate cancer, your clinical stage is determined from a digital rectal exam (DRE), biopsies, and imaging scans, and your blood PSA level.

  • Pathological stage. This measurement is based on an exam of your prostate after it has been removed by surgery. In some cases, the pathological stage may be higher than the clinical stage. This happens if the cancer has spread more than thought during clinical staging.

The stages are defined by Roman numbers I through IV. The lower the number, the less the cancer has spread. The higher the number, the more the cancer has spread. Stages I and II are sometimes referred to as early-stage prostate cancer. Stages III and IV are sometimes called advanced prostate cancer.

Stage I. In this stage, one of the following is true:

  • The tumor can't be felt by digital rectal exam (DRE) or seen on an ultrasound. It is found due to tests or surgery done for another reason. It has not spread beyond the prostate. The Gleason score is 6 or less. The PSA level is less than 10. (T1, N0, M0)

  • The tumor can be felt by DRE or seen on ultrasound. It is confined to less than half of one side of the prostate. It has not spread beyond the prostate. The Gleason score is 6 or less. The PSA level is less than 10. (T2a, N0, M0)

Stage IIA. Inthis stage, one of the following is true:

  • The tumor can't be felt by digital rectal exam (DRE) or seen on an ultrasound. It is found due to tests or surgery done for another reason. It has not spread beyond the prostate. The Gleason score is 7. The PSA level is less than 20. (T1, N0, M0)

  • The tumor can't be felt by digital rectal exam (DRE) or seen on an ultrasound. It is found due to tests or surgery done for another reason. It has not spread beyond the prostate. The Gleason score is 6 or less. The PSA level is at least 10 but less than 20. (T1, N0, M0)

  • The tumor can be felt by DRE or seen on ultrasound. It is confined to one side of the prostate. It has not spread beyond the prostate. The Gleason score is 7 or less. The PSA level is less than 20. (T2a or T2b, N0, M0)

Stage IIB. In this stage, one of the following is true:

  • The tumor can be felt by DRE or seen on ultrasound. It is in both sides of the prostate. It has not spread beyond the prostate. The Gleason score and PSA are any number. (T2c, N0, M0)

  • The tumor has not spread beyond the prostate. The PSA level is 20 or higher. The Gleason score is any number. (T1 or T2, N0, M0)

  • The tumor has not spread beyond the prostate. The Gleason score is 8 or higher. The PSA is any number. (T1 or T2, N0, M0)

Stage III. In this stage, thetumor has spread outside of the prostate. Cancer cells may be in some of the glands that produce semen (seminal vesicles). It has not spread to lymph nodes or anywhere else in the body. The Gleason score and PSA are any number. (T3, N0, M0)

Stage IV. In this stage, one of the following is true:

  • The tumor has spread outside of the prostate and seminal vesicles. It has reached nearby tissues such as the bladder's external sphincter, rectum, or the wall of the pelvis. It has not spread to the lymph nodes or distant parts of the body. The Gleason score and PSA are any number. (T4, N0, M0)

  • The cancer has spread to the lymph nodes. It has not spread to distant parts of the body. The Gleason score and PSA are any number. (Any T, N1, M0)

  • The cancer has spread to distant parts of the body. The Gleason score and PSA are any number. (Any T, any N, M1)

Talking with your health care provider

When your cancer is staged, your health care provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.