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Prostate Cancer: Staging

Staging of prostate cancer uses tumor size and spread and other markers to provide the risk for prostate cancer that comes back after treatment. It provides a prognosis to help decide on the best treatment choices.

Staging

The American Joint Committee on Cancer staging system is used most often for prostate cancer. It’s called the TNM system:

T stands for tumor. This notes the size of the tumor and where it is.
N stands for nodes. Lymph nodes are tiny organs all around the body. They help fight infections. N notes if cancer cells have spread to the nearby lymph nodes.
M stands for metastasis. Metastasis means the cancer has spread to other parts of the body. This may include a lung, bones, liver, or brain. It also includes lymph nodes that are not near your prostate.

Numbers are assigned to the T, N, and M categories.

Other parts of staging

Other information used to stage prostate cancer includes:

Your blood PSA level at the time the cancer is found
How different the cancer cells look from normal prostate cells (grade of cancer). This may be called the Grade Group. This is based on the Gleason score.

The stages of prostate cancer

The information above is then used to give a prostate cancer stage of I (1), II (2), III (3), or IV (4). Sometimes letters are used behind the stage number to give even more details. In general, the lower the number, the less the cancer has spread. The stages are:

Stage I. The cancer is only in 1 small part of the prostate. It has a low grade (1) and a fairly low PSA level (less than 10).
Stage II (A, B, or C). The cancer is only in the prostate but may be in both sides of the prostate. The grade of the cancer is 1 to 4, or the PSA level is higher (at least 10, but less than 20).
Stage III (A, B, or C). The cancer may have grown outside the prostate into nearby organs, such as the bladder or rectum. It has not spread to nearby lymph nodes. It can be any grade and any level PSA.
Stage IV (A or B). The cancer has grown into nearby tissues and has spread to nearby lymph nodes. It may also have spread to distant parts of the body, such as the bones. It can be any grade and any level PSA.

Talking with your healthcare provider

The staging system for prostate cancer is complex. Ask your healthcare provider about your stage and what it means. They may share more details about the exact stage of your cancer.