Stages of prostate cancer

There are three stages of prostate cancer – early, locally advanced, and late and each has different treatments. If prostate cancer is detected, your doctor or surgeon will need to determine which stage it is at, to decide which treatments will be available.

About 60% of men are diagnosed with early disease, 30% with locally advanced and 10% with advanced or late-stage disease. However, even when prostate cancer has reached the late stage, it may still be possible to slow down its growth.

Determining the stage

There are two common clinical methodologies for determining which stage the prostate cancer has reached.

Cancer aggressiveness (Gleason Score)

Prostate cancer tissue can look like normal prostate tissue. The extent to which the cancer tissue looks like normal tissue is called the cancer ‘grade’. Low grade cancer looks most like normal tissue and high grade cancer looks least like normal tissue. In general, the lower the grade, the less aggressive the cancer and the less likely it is to shorten life expectancy.

For prostate cancer, the Gleason grading system is normally used. For a needle biopsy, the grade can be 3, 4 or 5. 3 is the least aggressive and 5 is the most aggressive. Because prostate cancer is very variable in appearance, one grade is given to the most frequent appearance and a second grade to the second most frequent appearance under the microscope. The two Gleason grades are then added together to give the Gleason score, which ranges from 6-10. 6 (3+3) is least aggressive, 7 (4+3 or 3+4) is moderately aggressive and 8-10 is most aggressive.

Cancer staging (TNM-stages)

Prostate cancer is described as ‘early’, ‘locally advanced’ or ‘late’. It starts with changes in the cells of the prostate. The cells form a lump which may eventually be felt in a physical examination, and then other tests will be done to determine the spread, as described above. Surgeons describe how far the cancer has spread according to ‘TNM-stages’, standing for primary Tumour, Nodes and Metastasis.

Nodes can be N0 (negative) or N1 (positive). N1 indicates that the cancer has spread outside the prostate to one or more local lymph nodes. Metastasis can be M0 (negative) or M1 (positive). M1 indicates that the cancer has spread to a distant site.

Once the stage is determined, there will be different treatments available. Find out more about each here.

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