Prostate Cancer Stages and Risk Groups

Stage I prostate cancers can have 3 possible stage groupings.

Stage grouping: cT1, N0, M0, Grade Group 1 (Gleason score 6 or less), PSA less than 10

• The doctor can’t feel the tumor or see it with an imaging test such as transrectal ultrasound. It was either found during a transurethral resection of the prostate (TURP) or was diagnosed by needle biopsy done for a high PSA level [cT1].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1.
• The PSA level is less than 10.

Stage grouping: cT2a, N0, M0, Grade Group 1 (Gleason score 6 or less), PSA less than 10

• The tumor can be felt by digital rectal exam or seen with imaging, such as transrectal ultrasound, and is in one half or less of only one side (left or right) of the prostate [cT2a].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1.
• The PSA level is less than 10.

Stage grouping: pT2, N0, M0, Grade Group 1 (Gleason score 6 or less), PSA less than 10

• The prostate has been removed with surgery, and the tumor was still only in the prostate [pT2].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1.
• The PSA level is less than 10.

Stage IIA

Stage IIA prostate cancers can have 3 possible stage groupings.

Stage grouping: cT1, N0, M0, Grade Group 1 (Gleason score 6 or less), PSA at least 10 but less than 20

• The doctor can’t feel the tumor or see it with imaging such as transrectal ultrasound. It was either found during a transurethral resection of the prostate (TURP) or was diagnosed by needle biopsy done for a high PSA level [cT1].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1.
• The PSA level is at least 10 but less than 20.

Stage grouping: cT2a or pT2, N0, M0, Grade Group 1 (Gleason score 6 or less), PSA at least 10 but less than 20

• The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound and is in one half or less of only one side (left or right) of the prostate [cT2a]. Or the prostate has been removed with surgery, and the tumor was still only in the prostate [pT2].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1.
• The PSA level is at least 10 but less than 20.

Stage grouping: cT2b or cT2c, N0, M0, Grade Group 1 (Gleason score 6 or less), PSA less than 20

• The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound. It is in more than half of one side of the prostate [cT2b] or it is in both sides of the prostate [cT2c].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1.
• The PSA level is less than 20.

Stage IIB

Stage grouping: T1 or T2, N0, M0, Grade Group 2 (Gleason score 3+4=7), PSA less than 20

• The cancer has not yet spread outside the prostate. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 2.
• The PSA level is less than 20.

Stage IIC

Stage grouping: T1 or T2, N0, M0, Grade Group 3 or 4 (Gleason score 4+3=7 or 8), PSA less than 20

• The cancer has not yet spread outside the prostate. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 3 or 4.
• The PSA level is less than 20.

Stage IIIA

Stage grouping: T1 or T2, N0, M0, Grade Group 1 to 4 (Gleason score 8 or less), PSA at least 20

• The cancer has not yet spread outside the prostate. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2].
• The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1 to 4.
• The PSA level is at least 20.

Stage IIIB

Stage grouping: T3 or T4, N0, M0, Grade Group 1 to 4 (Gleason score 8 or less), any PSA

• The cancer has grown outside the prostate and might have spread to the seminal vesicles [T3], or it has spread into other tissues next to the prostate, such as the urethral sphincter (muscle that helps control urination), rectum, bladder, and/or the wall of the pelvis [T4].
• It has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 1 to 4.
• The PSA can be any value.

Stage IIIC

Stage grouping: any T, N0, M0, Grade Group 5 (Gleason score 9 or 10), any PSA

• The cancer might or might not be growing outside the prostate and into nearby tissues [any T].
• It has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
• The Grade Group is 5.
• The PSA can be any value.

Stage IVA

Stage grouping: any T, N1, M0, any Grade Group, any PSA

• The tumor might or might not be growing into tissues near the prostate [any T].
• The cancer has spread to nearby lymph nodes [N1] but has not spread elsewhere in the body [M0].
• The Grade Group can be any value.
• The PSA can be any value.

Stage IVB

Stage grouping: any T, any N, M1, any Grade Group, any PSA

• The cancer might or might not be growing into tissues near the prostate [any T] and might or might not have spread to nearby lymph nodes [any N].
• It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs [M1].
• The Grade Group can be any value.
• The PSA can be any value.

These prostate cancers are small and have not grown outside the prostate. They either can’t be felt on exam or seen on imaging (cT1), or they can but are only in a small area on 1 side of the prostate (cT2a). They have a Grade Group of 1 (Gleason score of 6 or less) and a low PSA level (less than 10).

These cancers usually grow very slowly and almost never cause any symptoms or other health problems.

These prostate cancers have at least 1 of these features:

• The cancer is in more than half of 1 side of the prostate (cT2b) or in both sides of the prostate (cT2c).
• The cancer has a Grade Group of 2 or 3 (Gleason score of 7).
• The PSA level is between 10 and 20 ng/mL.

However, these cancers don’t have any features that would put them in the high-risk or very high-risk groups.

Additional factors are used to split these prostate cancers into favorable intermediate-risk and unfavorable intermediate-risk categories.

Prostate cancers in this group have 1 or more of these high-risk features, but they don’t meet the criteria for very high-risk cancers (see below):

• The main tumor has grown outside the prostate (cT3 or cT4).
• The cancer has a Grade Group of 4 or 5 (Gleason score 8 to 10).
• The initial PSA level is more than 20.

These prostate cancers have a very high risk for the tumor growing or spreading to nearby lymph nodes or other parts of the body. These cancers have at least 2 of the following traits:

• The main tumor has grown outside the prostate (cT3 or cT4).
• The cancer has a Grade Group 4 or 5 (Gleason score 8 to 10).
• The initial PSA level is more than 40.

This test measures the activity of certain genes in prostate cancer cells taken from a biopsy. These are used to create a risk score on a scale from 0 to 1. A higher score means the cancer is more likely to spread to other parts of the body. This might be helpful in determining the best treatment options.

Another version of this test can be used after prostatectomy (surgery to remove the prostate) to help determine how likely the cancer is to come back somewhere else in the body and whether to consider further treatment.

This test measures the activity of certain genes in prostate cancer cells taken from a biopsy and reports it as a score on a scale from 0 to 100. Higher scores indicate a cancer that is more likely to grow and spread quickly and a higher risk of dying from prostate cancer.

This test measures the activity of a different set of genes in prostate cancer cells taken from a biopsy and reports it as a score on a scale from 0 to 10. Higher scores indicate a cancer that is more likely to grow and spread quickly and a higher risk of dying from prostate cancer.

This test measures the activity of a set of proteins in prostate cancer cells taken from a biopsy and reports it as a score that helps predict how likely a cancer is to grow and spread quickly.