Stages and grading

The results of your tests will tell your doctors more about the size of your tumour and whether it has spread beyond the prostate gland. This is known as the stage of the cancer. They also give information about how fast it might grow. This is the grade of the cancer.

The TNM system describes the size of the tumour, whether the cancer has spread to the lymph nodes and whether the cancer has spread to other organs.

The Gleason system is the most commonly used grading system for prostate cancer. It looks at the patterns of the cancer cells in the prostate.

Early prostate cancer is also divided into risk groups. Your doctor will decide which risk group you are in depending on your PSA level, the stage of your cancer and the grade.

Early (localised) prostate cancer has not spread to the lymph nodes or other parts of the body. If you would like more information about the staging and grading of your cancer you should talk to your doctor.

Staging of prostate cancer

The stage of a cancer is a term used to describe its size and whether it has spread. A commonly used staging system is the TNM staging system.


TNM staging

The TNM system gives information about the tumour, the lymph nodes and whether the cancer has spread (metastasised).

T stands for tumour

Doctors put a number next to the T to describe the size and spread of the cancer.

T1 – The tumour is within the prostate gland. It is too small to be detected during a rectal examination, but may be picked up through tests such as a PSA test, a biopsy or a transurethral resection of the prostate gland (TURP). This is an operation to make passing urine easier by removing part of the prostate gland. There are generally no symptoms with T1 tumours.

T2 – The tumour is still within the prostate gland but is large enough to be felt during a digital rectal examination, or it shows up on a scan. Often there are no symptoms.

The T2 stage is divided into:

  • T2a – The tumour is only in one half of one of the two lobes that make up the prostate gland.
  • T2b – The tumour is in more than one half of one of the lobes in the prostate gland.
  • T2c – The tumour is in both lobes of the prostate gland.

T1 and T2 tumours are known as early (localised) prostate cancer. T3 and T4 tumours are known as locally advanced prostate cancer because the cancer has started to spread outside the prostate gland and may be invading surrounding structures.

Prostate cancer T1-3
Prostate cancer T1-3

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If the cancer has spread to other parts of the body, it’s known as metastatic, secondary, or advanced prostate cancer.

N stands for nodes

This describes whether there are any lymph nodes near the prostate gland that have cancer in them. The N may have an X or a number written next to it, which gives information about the nodes that were examined:

  • NX – The lymph nodes were not examined.
  • N0 – The lymph nodes were examined but no cancer was found.
  • N1 – Cancer was found in the lymph nodes.

If you have early prostate cancer, you will most likely see NX or N0 because the cancer is just in the prostate.

M stands for Metastasis

Metastasis means that the cancer has spread to other parts of the body, such as the bones.

The M may have a number written next to it, which gives information about where the cancer has spread to:

  • M0 – The cancer has not spread to other parts of the body.
  • M1 – The cancer has spread to another part of the body, such as the bones, lung or liver.

If you have early prostate cancer, you will most likely see M0 because the cancer is just in the prostate.

You can talk to your doctors about your TNM staging. They will be able to explain it to you. Our cancer support specialists can also tell you more about TNM staging. You can call them on 0808 808 00 00.


Grading

The grade of a cancer gives an idea of how quickly it might grow. Prostate cancer is graded according to how the cancer cells look when the biopsy sample is looked at under the microscope.

The Gleason system is the most commonly used grading system. It looks at the pattern of cancer cells within the prostate. There are five patterns, which are graded from 1–5. 1 is very similar to normal prostate tissue, whereas 5 is very different to normal tissue. Only grades 3 to 5 are cancer.

All your biopsy samples are graded. The most common grade in the samples and the highest grade of the other samples are added together. This gives a Gleason score that ranges between 6–10.

Low-grade cancers with a Gleason score of 6 are usually slow-growing and less likely to spread. High-grade cancers  have a Gleason score of 8–10. They are more likely to grow quickly and to spread.


Prostate cancer risk groups

Early (localised) prostate cancer is divided into risk groups. These help doctors decide on the best treatment options. There are three risk groups:

  • Low risk means the prostate cancer is unlikely to grow for many years.
  • Intermediate risk means the prostate cancer is unlikely to grow for a few years.
  • High risk means the prostate cancer is more likely to grow or spread in a few years.

To work out your risk group your doctor will look at your Gleason score, your PSA level and the stage of your cancer. If you would like more information about your risk group, ask your doctor.

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