After thoroughly assessing a patient’s prostate cancer, medical oncologists will assign the cancer a stage. The staging system is standard for all cancer types and is used to characterize how far cancer has spread. The most widely used staging system for prostate cancer is the American Joint Committee on Cancer (AJCC) TNM system. Using this system, oncologists consider the following:
- The extent of the primary tumor
- Whether cancer has spread to nearby lymph nodes
- Whether cancer has spread (metastasized) to other areas of the body
- The prostate-specific antigen (PSA) level from blood testing
- The grade group, which is a measure of how likely the cancer is to grow and spread quickly
The main stages of prostate cancer range from I to IV. With this staging system, the higher the number, the more the cancer has spread.
Stage I Prostate Cancer
Prostate cancer in its earliest stage is classified as Stage I. At this point, the tumor is only in the prostate gland and is very small and slow-growing. Patients with Stage I prostate cancer often do not notice any symptoms or health problems.
Additionally, the tumor may be difficult to detect during Stage I prostate cancer. A doctor may not be able to feel the tumor during a digital rectal exam or see it on an ultrasound scan. Detecting prostate cancer at this stage gives patients the greatest chance of cure and survival.
- Grade group: 1
- PSA level: Less than 10 ng/mL or between 10 and 20 ng/mL
- 5-year relative survival rate: Nearly 100%
Treatment options for Stage I prostate cancer can include active surveillance, radiation therapy, and radical prostatectomy.
Stage II Prostate Cancer
If undetected, early prostate cancer can progress to Stage II. Tumors in this stage are much larger than tumors in Stage I. Because of this, physicians are much more likely to recommend a more proactive treatment plan.
With Stage II prostate cancer, there is a greater chance of cancer coming back after treatment (recurrence). To guard against recurrence, continued surveillance and regular checkups are necessary.
- Grade group: 1 (IIA), 2 (IIB), 3 (IIC)
- PSA level: At least 10 ng/mL but less than 20 ng/mL
- 5-year relative survival rate: Nearly 100%
Treatment approaches for Stage II prostate cancer generally are more aggressive than those used in Stage I. They can include active surveillance, radiation therapy, radical prostatectomy, and clinical trials, among others.
Stage III Prostate Cancer
In Stage III prostate cancer, the cancer has started to spread and is no longer affecting only the prostate gland. At this point, the cancer also may be in nearby tissues, lymph nodes, or even distant organs. To help patients and their doctors gain control over the cancer, more aggressive treatment is typically required. In Stage III, the risk of recurrence also increases.
- Grade group: 1 to 4 (IIIA, IIIB), 5 (IIIC)
- PSA level: At least 20 ng/mL (IIIA), or any PSA level (IIIB, IIIC)
- 5-year relative survival rate: Nearly 100%
When treating Stage III prostate cancer, care plans can include several treatment options, including radiation therapy plus hormone therapy, radical prostatectomy, and clinical trials.
Stage IV Prostate Cancer
Stage IV prostate cancer is the most progressed form of the disease. When a patient is diagnosed with Stage IV prostate cancer, it means the cancer has already spread to nearby areas, particularly the bladder or rectum. It also may have spread to the lymph nodes, bones, lungs, liver, and other distant organs.
Due to the advanced nature of the cancer and how much it has spread, the 5-year survival rate decreases drastically. At this point, the goal of treatment is to control the cancer, extend survival, and make the patient as comfortable as possible.
- Grade group: Any grade group
- PSA level: Any PSA
- 5-year relative survival rate: Approximately 30% (distant stage IVB cancer)
Treatment options for Stage IV prostate cancer can include active surveillance, hormone therapy, chemotherapy, radiation, radical prostatectomy, surgery to relieve symptoms, and clinical trials.