Your Guide to Prostate Cancer Stages

One of the most critical steps in diagnosis, your prostate cancer stage will form the foundation for planning your journey ahead. Despite this, the acronyms and medical jargon used may be a little overwhelming at times. Here, we break down these terms simply to help you better understand the significance behind your results.

Staging is done based on the extent of cancer spread, prostate-specific antigen (PSA) and Gleason score. It helps to standardize treatment planning, and the most commonly used is the American Joint Committee on Cancer (AJCC)’s staging system.

TNM System

Firstly, the TNM system is used to describe the extent of tumor growth. Numbers or letters following the letters T (tumor), N (node), and M (metastasis) act as a quick code of reference for your cancer state.

• T category indicates the extent of spread of the original tumor.
  • Clinical T (cT) grades are based on your physical exam, biopsy, and imaging tests.
  • Pathological (pT) grades are more accurate, and consider the whole prostate. However, they can only be completed with complete prostate removal.

• N category indicates the extent of cancer spread to the neighboring lymph nodes
  • N0: No spread to nearby lymph nodes
  • N1: Presence of spread to nearby lymph nodes in the pelvis

• M category indicates the level of cancer metastasis
  • M0: No metastasis has been found
  • M1: Cancer has metastasized deeper into the body

After identifying your tumor’s TNM categories, information about your PSA level and tumor Gleason score will be used to pinpoint your cancer stage:

If you have been diagnosed with prostate cancer stage 1 to 3, this means that your cancer hasn’t spread yet, and remains “localized” around the prostate. Stage 4 prostate cancer refers to cancer that has spread to other parts of your body, and is considered “metastatic” and advanced prostate cancer.

Beyond staging, clinicians can also classify your tumor progression by understanding how your cancer is behaving at the microscopic level. This is especially useful when dealing with localized prostate cancer.

The Gleason score was developed in the 1960s to easily categorize different patterns of prostate cancer tissue based on their potential aggressiveness. Over the past decade, a new grading system has since been proposed and validated to categorize prostate cancer cases based on the Gleason score, making it simpler for clinicians to decide on the best treatment options for you:

While these terms are typically used by your healthcare professionals to understand your case quickly, understanding them as a patient can help you to visualize your disease progress and prepare for treatment discussions.