What Are the Stages of Prostate Cancer?

Posted on January 5, 2023 in Prostate Cancer

Written by Dr. McGinnis

Learn more about the author

If you are diagnosed with prostate cancer, the first thing your doctors will do is assess if and how much the cancer has spread. This process is called staging.

Prostate cancer, like all cancers, will fall into one of four stages. In stage 1, the cancer has not spread. The succeeding stages define gradually advanced stages of cancer up to stage 4, which describes cancer that has spread to other areas of the body.

Doctor going over states of prostate cancer with patient

What is Prostate Cancer?

Prostate cancer affects the prostate gland. The prostate gland is a small, walnut-shaped gland that produces seminal fluid. Because the prostate is found only in men, prostate cancer only occurs in men.

Prostate cancer occurs when abnormal cells in the prostate begin to multiply faster than normal cells, forming a tumor. It usually grows slowly and is limited to the prostate, but it does sometimes spread or grow quickly. Most men with prostate cancer do not experience symptoms. For a complete guide on Prostate Cancer, download our eBook here.

prostate with cancer cells

The TNM Staging System

Most doctors utilize the TNM staging system when staging cancers, including prostate cancer. Doctors utilize evaluative tools like diagnostic tests, imaging scans, and possibly surgery to obtain a sample of the tumor. With their findings, they answer the following questions to define the different aspects of the staging system:

  • T (Tumor): Where is the tumor located and how large is it?
  • N (Node): Has the cancer spread to and affected lymph nodes? If yes, where did it spread and how many nodes is it impacting?
  • M (Metastasis): Has the cancer spread to and affected other parts of the body? If yes, where did it spread and how large is that cancer?
  • How likely is it that the cancer will spread?
  • What are the PSA levels? (More on PSA below)

Clinical & Pathological Staging

Using the TNM staging system, oncologists may utilize clinical or pathological staging. These two types of staging indicate to doctors how likely it is the cancer will spread, what treatments to recommend, and other details about the tumor.

Clinical Staging

Clinical staging is non-invasive as it is done prior to surgery. It might include imaging tests and physical examinations, a needle prostate biopsy, a prostate-specific antigen (PSA) test, and a Gleason score. If your doctor believes more information is needed to accurately stage your cancer, they will move on to pathological staging.

Clinical staging is indicated with a lowercase “c” before the TNM stage.

Prostate-Specific Antigen (PSA) Test

When using clinical staging to diagnose prostate cancer, doctors largely rely on the prostate-specific antigen (PSA) test. This test measures the levels of PSA, a protein produced by prostate gland cells, in the blood.

Although normal cells produce PSA, cancerous cells produce more of it. Therefore, higher levels of PSA may indicate the presence of prostate cancer. While each case is different, doctors utilize the following metrics to determine the risk of PSA levels:

  • Low Risk: PSA level less than 4 ng/mL blood
    At this level, it is unlikely patients have prostate cancer (but not impossible). Depending on your symptoms and circumstances your doctor may recommend a biopsy to glean more definitive information.
  • Borderline Risk: PSA level between 4 and 10 ng/mL blood
    If patients test in this range, there is a small chance—about 25%—they have prostate cancer. Your doctor will likely pursue further, more definitive testing.
  • Higher Risk: PSA level greater than 10 ng/mL blood
    There is a 50% chance patients with these higher PSA levels have cancer. Your doctor will pursue further testing to determine the extent of your cancer.

Pathological Staging

Pathological staging is performed following surgery to assess the tumor and its spread. Because it allows doctors to analyze the tumor’s cells closely, pathological staging is generally more accurate.

It is indicated with a lowercase “p” before the TNM stage.

Gleason Score

If your doctor detects prostate cancer following pathological staging, like a biopsy, he or she will score it using the Gleason system. This system ranges from 1 to 5. Scores of 1 indicate the cancerous cells analyzed look like normal prostate cells. Scores of 5 indicate the cells look very abnormal. The scores 2 through 4 describe cells between these two extremes.

Your doctor will utilize samples from two different areas to determine your Gleason score. These two areas are graded, and their numbers are added to determine your Gleason score. Therefore Gleason scores can be as high as 10.

Understanding Prostate Cancer Stages


Prostate Cancer, Stage I

In stage I prostate cancer, the cancer is limited to one side of the prostate, and it has not spread to lymph nodes or other areas of the body. Both the PSA levels and Gleason score are low. At this stage, the cancer tends to grow very slowly and is therefore largely curable. The survival rate for stage I prostate cancer is nearly 100%.


Prostate Cancer, Stage II

While the cancer may be present across the prostate gland, it has not spread to lymph nodes or other areas of the body. The PSA levels and Gleason score will likely be higher than average, but the survival rate for this stage of prostate cancer is still nearly 100%.


Prostate Cancer, Stage III

In stage III, the cancer has spread to other tissues or is on the brink of spreading to lymph nodes or other areas of the body. If the cancer has spread to other areas, it is localized near the prostate and has not affected lymph nodes. The survival rate is still almost 100%.


Prostate Cancer, Stage IV

This is the most advanced stage of prostate cancer. In this stage, the cancer has spread to areas beyond the prostate and nearby tissue, like the lymph nodes, bones, or other organs. When diagnosed with stage IV prostate cancer, the five-year survival rate is about 30%.

The American Cancer Society provides further details regarding each of these stages, including specific PSA level and Gleason scores and information on sub-stages. Your cancer care team will utilize your prostate cancer’s stage to determine your cancer treatment plan.

Radiation Therapy for Prostate Cancer

Depending on the stage of your cancer, it is likely your doctor will incorporate radiation therapy into your treatment plan. Radiation uses extremely accurate, high-energy rays to weaken or kill cancer cells. It is non-invasive and often has few symptoms

For lower stages of prostate cancer, radiation therapy may be your first treatment. It is also often used alongside hormone therapy for prostate cancers that have grown to nearby tissues. Even in higher stages of prostate cancer, radiation therapy can be utilized as an additional treatment if surgery does not remove all of the cancer or if the cancer returns.

SERO and Your Prostate Cancer

Navigating a prostate cancer diagnosis and treatment, including understanding your cancer’s stage, can be overwhelming. SERO’s dedicated care team is here to help, from explaining the details of your exact diagnosis to offering state-of-the-art radiation treatments.

Prostate cancer is a frightening diagnosis, but most patients experience a full recovery. SERO is here to help you do the same.