The stage is one of the most important factors in selecting treatment options. It is also the most significant (but not the only) factor in predicting a man's outlook for survival (prognosis). A prostate cancer's stage indicates how far it has spread within the prostate, to nearby tissues, and to other organs.
An overview of the stages of prostate cancer:
Stage I: The cancer cannot be found during a digital rectal exam. It is found as a result of prostate biopsies for an elevated or increasing PSA or by chance when surgery is done for another reason, usually for lower urinary tract symptoms. (Stage I=T1)
Stage II: The cancer is palpable — a nodule is detected on prostate exam, but it has not spread outside the prostate. (Stage II=T2)
Stage III: The cancer has spread outside the prostate. It may be in the tissues adjacent to the prostate or invaded the seminal vesicles. It has not spread to the lymph nodes. (Stage III=T3)
Stage IV: The cancer may be in nearby pelvic muscles or organs (beyond the seminal vesicles). It may have spread to the lymph nodes. It may have spread to other parts of the body. (Stage IV includes T4 and spread to the pelvic lymph nodes or distant sites)
A staging system is a standardized way in which the cancer care team describes the extent to which a cancer has spread. The TNM System of the American Joint Committee on Cancer (AJCC) is the most commonly used system in the United States. The TNM System describes the extent of the primary tumor (T), the absence or presence of spread to the nearby lymph nodes (N), and the absence or presence of spread to distant organs (M). The spread of cancer is called metastasis.
A detailed look at the TNM System of Cancer stages:
T CATEGORIES There are two types of T classifications for prostate cancer:
The clinical stage is used in making treatment decisions. However, the clinical stage may underestimate the amount of cancer and the presence of metastasis (spread of the cancer). If surgery is done, the pathologic stage assigned after surgery is more accurate. Men who do not have a radical prostatectomy (surgery to remove the prostate gland, seminal vesicles, and nearby tissues) do not have a pathologic T stage determined. There are 4 categories for describing the prostate cancer's T stage.
TX is the primary tumor cannot be assessed.
T0 is there is no evidence of primary tumor.
T1 refers to a tumor that is not felt during a digital rectal exam, but cancer cells are found in a prostate biopsy or prostactectomy specimen. T1 prostate cancers can be further subclassified as T1a, T1b and T1c.
T2 means that a doctor can feel the prostate cancer by DRE and that the cancer is thought to remain within the prostate gland. This category is subclassified into T2a and T2b and T2c.
T3 means the cancer has spread beyond the outer rim (capsule) of the prostate into the connective tissue next to the prostate and/or the seminal vesicles and/or the bladder neck. Cancer has not spread to any other organs. This group is subdivided into T3a and T3b.
T4 means that the cancer has spread to tissues next to the prostate (other than the seminal vesicles or bladder neck), such as the external sphincter (muscle that helps control urination), the rectum, the muscles in the pelvis, or the wall of the pelvis.
The N category is determined by whether or not the cancer has been found in nearby lymph nodes.
The M category stands for metastasis (whether or not the cancer has spread to distant organs).
Recurrent cancer is cancer that has come back (recurred) after a time when it was in remission (could not be detected). It may recur in or near the prostate, or in any other part of the body, such as the bones. Read more information on recurrent cancer.