Prostate Cancer: Stages of Prostate Cancer

What Is Staging?

Once prostate cancer has been diagnosed, more tests are done to find out the size and location of the cancer, and if the cancer has metastasized (spread) beyond the prostate. This process is called staging. Knowing the stage of the cancer is important for planning the right treatment.

Several systems are used to stage prostate cancer. The most common are the ABCD system and the TNM system.

ABCD System

This is the simplest method of staging prostate cancer. It breaks down the cancer into four categories:

• Stage A. This is prostate cancer in its earliest stage. Typically, prostate cancer in this stage causes no symptoms. It is located entirely within the prostate gland, but is too small to be detected by a digital rectal exam (DRE). In many cases, Stage A prostate cancer is uncovered by diagnosing and treating another prostate-related problem, such as a benign (noncancerous) tumor, or during a follow-up for an abnormal PSA blood test.
• Stage B. In this stage, the tumor (mass of cancer cells) is still confined within the prostate but is now big enough to be detected by DRE or ultrasound imaging
• Stage C. This stage indicates that the cancer is more advanced. The cancer has spread beyond the capsule, or outer layer, of the prostate to the immediately surrounding tissue but not to distant organs.
• Stage D. The cancer has spread to distant areas of the body, often the lymph nodes or bones.

TNM System

TNM is a system that determines the extent of the cancer by assessing the size of the tumor, seeing if the cancer has spread to the lymph nodes, and evaluating the degree to which the cancer has spread, or metastasized, to other areas of the body.

The TNM system is more specific in how it categorizes prostate cancer and is more widely used. It gauges the severity of the cancer on a rising scale.

T = Tumor size

• Stage T1. Similar to Stage A in the ABCD system, Stage T1 prostate cancer is confined to the prostate and is not detectable by DRE or ultrasound.
• Stage T2. The tumor is confined to the prostate but is detectable by DRE or ultrasound.
• Stage T3. The cancer has spread to tissue surrounding the prostate.
• Stage T4. The cancer has spread to organs near the prostate, such as the bladder, but is still within the pelvic region.

N = Nodes (extend of spread to the lymph nodes)

• Stage N0: The cancer has not spread to the lymph nodes.
• Stage N1, N2, N3: The cancer has spread to the lymph nodes. Higher numbers means more extensive spread.

M = Metastasis (extent of spread to other parts of the body)

• Stage M0: The cancer has not spread to other parts of the body.
• Stage M1: The cancer has spread to the bones or to distant parts of the body.

In addition to the stages listed above, cancer is also referred to as recurrent, which means the disease has come back (recurred) after it has been treated. The cancer may recur in the prostate or in another part of the body.

Reviewed by the doctors at The Cleveland Clinic Urological Institute.