Stages of Prostate Cancer - How To Beat Prostate Cancer

Understanding the stages of prostate cancer helps you determine how serious the disease is and which treatment options work best. Doctors use a staging system to describe how far the cancer has grown, whether it stays in the prostate, or spreads to nearby tissues, lymph nodes, or distant body parts. They typically divide prostate cancer into four main stages (I–IV), with each stage showing a different level of progression. This staging guides treatment decisions and also helps predict a person’s outlook.

Overview of the Stages of Prostate Cancer

Doctors classify prostate cancer into different stages based on how far it has spread. They use staging to determine the appropriate treatment and also manage the disease. The four main stages—Stage I, II, III, and IV—describe the extent of the cancer and also its spread to nearby tissues or organs.

The cancer remains in the prostate but has grown. Doctors may find it in one or both sides of the prostate. The PSA level may rise.

Stage 2A Prostate Cancer — Stage IIA prostate cancer. Doctors find cancer only in the prostate. They may find it in one-half or less of one side of the prostate. The prostate-specific antigen (PSA) level measures at least 10 but less than 20, and the Grade Group is 1. Alternatively, doctors may find cancer in more than one-half of one side or in both sides of the prostate. The PSA level is less than 20 and the Grade Group is 1.

Stage 2B Prostate Cancer — Stage IIB prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is less than 20 and the Grade Group is 2.

Stage 2C Prostate Cancer — Stage IIC prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is less than 20 and the Grade Group is 3 or 4.

The cancer remains confined to the prostate and may not show during a digital rectal exam. The PSA level is usually low.

Stage 1 Prostate Cancer — Stage I prostate cancer. Doctors find cancer only in the prostate. They do not feel it during a digital rectal exam but detect it through a needle biopsy prompted by high PSA levels or from tissue removed during surgery for other reasons.
The PSA level is less than 10 and the Grade Group is 1; or doctors feel the cancer during a digital rectal exam and find it in half or less of one side of the prostate.
The PSA level is less than 10 and the Grade Group is 1.

Cancer has spread beyond the prostate to nearby tissues or organs such as the seminal vesicles or pelvic wall, with a higher PSA level.

Stage 3A — Stage IIIA prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is at least 20 and the Grade Group is 1, 2, 3, or 4.

Stage 3B — Stage IIIB prostate cancer. Cancer has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The prostate-specific antigen can be any level and the Grade Group is 1, 2, 3, or 4.

Stage 3C — Stage IIIC prostate cancer. Doctors find cancer in one or both sides of the prostate, and it may have spread to the seminal vesicles or nearby tissues or organs, such as the rectum, bladder, or pelvic wall.
The prostate-specific antigen can be any level and the Grade Group is 5.

Cancer has spread to distant parts of the body, including bones or lymph nodes, significantly impacting prognosis and treatment options.

Stage 4A — Stage IVA prostate cancer. Cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The prostate-specific antigen can be any level and the Grade Group is 1, 2, 3, 4, or 5.

Stage 4B — Stage IVB prostate cancer. Cancer has spread to other parts of the body, such as the bones or distant lymph nodes.

Doctors use the Grade Group and PSA level to stage prostate cancer.

The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Grade Group. Doctors use the tissue samples removed during the biopsy to determine the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and also spread slowly.

The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.

Grade Group 1 is a Gleason score of 6 or less.
Grade Group 2 or 3 is a Gleason score of 7.
Grade Group 4 is a Gleason score 8.
Grade Group 5 is a Gleason score of 9 or 10.

The PSA test measures the level of PSA in the blood. The prostate makes PSA, a substance that often increases in the blood of men with prostate cancer.

Common Tests for Staging:

Prostate Cancer Bone Scan — Bone scan. Doctors inject a small amount of radioactive material into the patient’s bloodstream, where it collects in abnormal bone cells. As the patient lies on a table that moves under the scanner, the system detects the radioactive material and also creates images on a computer screen or film.

Bone Scan: Detects cancer spread to bones.
MRI & CT Scan: Provides detailed images to determine the extent of the cancer.
PSA Testing: Measures prostate-specific antigen levels, which can indicate the presence of cancer.
Biopsy: Confirms the cancer’s presence and helps determine its aggressiveness based on the Gleason score.

Healthcare providers use the stage of prostate cancer to develop an individualized treatment plan to manage the disease. You should get regular screenings and discuss your health with your doctor to monitor and detect prostate cancer early, improving treatment outcomes.