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Stages of Prostate Cancer

Prostate cancer is staged in a slightly different way than some other types of cancer. While it considers the tumor size, lymph node involvement and whether it's spread to other areas of the body, there are two additional factors used to determine prostate cancer stage.

There are 2 types of staging for prostate cancer:

  • Clinical staging. This is based on the results of a digital rectal exam (DRE), prostate-specific antigen (PSA) testing, and Gleason score. These test results will help determine whether x-rays, bone scans, computed tomography (CT) scans, or magnetic resonance imaging (MRI) are also needed. If scans are needed, they can add more information to help the doctor figure out the clinical stage.

  • Pathologic staging. This is based on information found during surgery, plus the laboratory results of the prostate tissue removed during surgery, also called the pathology. The surgery often includes the removal of the entire prostate and some lymph nodes. Examination of the removed lymph nodes can provide more information for pathologic staging.

Grade group - There are five grades of prostate cancer. Grade 1, which is low grade and slower growing, through Grade 5, which is high grade and rapidly growing.  The grade is related to the Gleason score determined during the biopsy. 

  • Grade 1: Gleason score of 6 or less
  • Grade 2: Gleason score of 3+4=7
  • Grade 3: Gleason score of 4+3=7
  • Grade 4: Gleason score of 8
  • Grade 5: Gleason score of 9 or 10

PSA levels - In stages 1 through 3, the oncologist will consider whether the PSA test result was above 10 but below 20 (medium), or above 20 (high). At Stage 4 prostate cancer, the PSA level doesn't have as much of an impact on the treatment path that will be recommended because it has moved outside of the prostate.

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Stage I Prostate Cancer

The cancer can’t be felt during a digital rectal exam, and it can’t be seen on a sonogram. It’s found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. The grade group is 1, the Gleason score is no greater than 6, PSA less than 10. 

A medical illustration showing Stage 1 of prostate cancer.

Stage II Prostate Cancer

The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram. Some men at this stage may be be able to wait before treatment depending on the Gleason score. If it was 4+3=7, the cancer is more advanced and treatment may need to begin.

  • Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated. The grade group is 1, the Gleason score is 6 or less, PSA at least 10 but less than 20. 

A medical illustration showing Stage 2A of prostate cancer.
  • Stage IIB: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated. The grade group is 2, PSA less than 20.
A medical illustration showing Stage 2B of prostate cancer.
  • Stage IIC: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated. The grade group is 3, PSA is less than 20.
A medical illustration showing Stage 2C of prostate cancer.

Stage III Prostate Cancer

The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.

  • Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The grade group is 1 to 4, the Gleason score is 8 or less, PSA at least 20.

A medical illustration showing Stage 3A of prostate cancer.
  • Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum. The grade group is 1 to 4, the Gleason score is 8 or less, PSA any level. 
A medical illustration showing Stage 3B of prostate cancer.
  • Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells. The grade group is 5, PSA any level. 
A medical illustration showing Stage 3C of prostate cancer.

Stage IV Prostate Cancer

When prostate cancer spreads beyond nearby lymph nodes to the bones or other organs, the cancer is called metastatic or distant.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer. Doctors call the new tumor “distant” or metastatic disease.

The cancer has spread beyond the prostate. 

  • Stage IVA: The cancer has spread to the regional lymph nodes. The grade group is any value, PSA any level.
A medical illustration showing Stage 4A of prostate cancer.
  • Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones. The grade group is any value, PSA any level. 
prostate-stage-4B
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