Stages of Prostate Cancer

If cancer is found in the prostate, your doctor needs to know the stage, or extent, of the disease. Staging is an attempt to determine whether the cancer has spread and, if so, what areas of the body are affected. Various blood and imaging tests are used to learn the stage of the disease. Treatment decisions depend on these findings.

In general, the different systems attempt to classify stage of the cancer by evaluating the following:

• The size and location of the primary prostate tumor
• Whether the cells have spread beyond the prostate gland and to other organs or areas
• Whether the cells have spread to lymph nodes
• Whether the cancer cells have metastasized into another part of the body

The stages below represent the common staging system in the United States used for prostate cancer. The system, called TNM, describes the extent of the primary tumor (T), if the cancer has metastasized to lymph nodes (N) and if the cancer has metastasized elsewhere (M). There are two types of stages: the clinical stage (based on the digital rectal exam, needle biopsy or transrectal ultrasound results) and the pathological stage (based on surgical removal of the entire prostate gland, the seminal vesicles and possibly lymph nodes.

• T Stages (Primary Tumor)
• N Stages (Regional Lymph Nodes)
• M Stages (Distant Metastasis)

T Stages (Primary Tumor)

In the T stages, the cancer is localized in the prostate gland and surrounding areas.

Clinical
TX -- Primary tumor cannot be assessed
T0 -- No evidence of primary tumor
T1 -- Cannot detect tumor with imaging tests
T1a -- Less than 5 percent of the prostate is affected by the tumor
T1b -- More than 5 percent of the prostate is affected by the tumor
T1c -- Tumor identified by needle biopsy, PSA elevated
T2 -- Tumor confined within prostate
T2a -- Tumor affects one-half of one lobe or less
T2b -- Tumor affects more than one-half of one lobe but not both lobes
T2c -- Tumor affects both lobes
T3 -- Tumor extends through the prostate capsule
T3a -- Tumor extends beyond the prostate capsule
T3b -- Tumor invades seminal vesicle(s)
T4 -- Tumor is fixed or invades surrounding areas, such as the bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

Pathologic
pT2 -- Tumor confined to the prostate
pT2a -- Tumor affects one-half of one lobe or less
pT2b -- Tumor affects more than one-half of one lobe but not both lobes
pT2c -- Tumor affects both lobes
pT3 -- Tumor extends beyond the prostate
pT3a -- Tumor extends beyond the prostate
pT3b -- Tumor invades seminal vesicle(s)
pT4 -- Tumor invades the bladder, rectum


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N Stages (Regional Lymph Nodes)

A N0 stage indicates the cancer has not spread to the lymph nodes. N1 indicates the cancer has spread to one or more pelvic lymph nodes.

Clinical
NX -- Regional lymph nodes were not assessed
N0 -- Tumor has not spread to regional lymph nodes
N1 -- Tumor has spread to regional lymph nodes

Pathologic
pNX -- Regional lymph nodes were not assessed
pN0 -- Regional lymph nodes not affected by tumor
pN1 -- Regional lymph nodes affected by tumor


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M Stages (Distant Metastasis)

A M0 stage indicates the cancer has not metastasized beyond the local lymph nodes, while M1 indicates the cancer has metastasized to distant lymph nodes and/or to other organs.

MX -- Distant metastasis cannot be assessed
M0 -- No distant metastasis
M1 -- Distant metastasis
M1a -- Non-regional lymph nodes affected by tumor
M1b -- Bones affected by tumor
M1c -- Other sites affected by tumor with or without bone disease
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