What Do Cancer Stages And Grades Mean
The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.
If you’re diagnosed with cancer, you may have more tests to help determine how far it has progressed. Staging and grading the cancer will allow the doctors to determine its size, whether it has spread and the best treatment options.
A New Perspective On Your Health
For many people, survivorship serves as a strong motivator to make lifestyle changes.
People recovering from prostate cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, maintaining a healthy weight, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.
It is important to have recommended medical checkups and tests to take care of your health.
Talk with your health care team to develop a survivorship care plan that is best for your needs.
What About Trans People
People born with a prostate can develop prostate cancer. Individuals born without a prostate cannot develop prostate cancer.
Trans women who use hormone therapy such as estrogen may have a lower risk, but the risk is still present.
Anyone born with a prostate should speak to their doctor about screening for prostate cancer.
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More About The Prostate
The prostate gland sits below the bladder and surrounds part of the urethra – the tube that carries urine from the bladder to the penis.
The prostate gland is only found in males and it produces a fluid that mixes with sperm to make semen . Seminal fluid helps sperm to travel and survive and it is stored in the seminal vesicles that sit on top of the prostate gland. Seminal fluid helps sperm to be carried out of a mans body during orgasm.
The prostate gland also produces prostate-specific antigen , a protein that helps to make semen more watery.
In younger men the prostate gland is about the size of a walnut, but it can grow larger as a man ages.
The Ajcc Tnm Staging System
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main tumor *
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of the body
- The PSA level at the time of diagnosis
- The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .
*There are 2 types of T categories for prostate cancer:
- The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.
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Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
How Is Cancer Diagnosed
In order to treat your cancer, your healthcare provider needs to know the location of the tumor, the stage and whether you are strong enough to handle the treatment. They will perform a comprehensive examination and ask you about your symptoms. They may also order certain tests, including:
- Blood tests.
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What Are The 5 Types Of Cancer
There are five main types of cancer. These include:
- Carcinoma. This type of cancer affects organs and glands, such as the lungs, breasts, pancreas and skin. Carcinoma is the most common type of cancer.
- Sarcoma. This cancer affects soft or connective tissues, such as muscle, fat, bone, cartilage or blood vessels.
- Melanoma. Sometimes cancer can develop in the cells that pigment your skin. These cancers are called melanoma.
- Lymphoma. This cancer affects your lymphocytes or white blood cells.
- Leukemia. This type of cancer affects blood.
What Causes Prostate Cancer
Researchers don’t know for sure what causes prostate cancer. They do know that it happens when there are changes in the genetic material .
Sometimes these genetic changes are inherited, meaning that you are born with them. There are also certain genetic changes that happen during your lifetime that can raise your risk of prostate cancer. But often the exact cause of these genetic changes is unknown.
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Stages Types And Grades Of Prostate Cancer
The tests and scans you have to diagnose prostate cancer give information about:
- the type of cell the cancer started in and where it began
- how abnormal the cells look under the microscope
- the size of the cancer and whether it has spread
In the UK, doctors use the Grade Groups or Gleason score to grade prostate cancer. Doctors now use the Grade Groups and other information to divide prostate cancer into 5 groups. This is called the Cambridge Prognostic Group .
You might also be told about the TNM stage, or you may see this on your pathology report. Another way doctors may describe your cancer is as localised, locally advanced and metastatic prostate cancer.
Grade: How Aggressive Is The Cancer
The pathology team will take a biopsy sample and prepare it with chemicals, then make extremely fine slices of the tissue to examine under the microscope. If prostate cancer is found when looking at biopsied tissue under a microscope, the pathologist assigns a grade to the cancer. There are 2 grading systems currently in use, which can be confusing for patients.
The classical grading system for prostate cancer is called the Gleason score, which ranges from 6 to 10 .
In 2014, the World Health Organization reorganized the Gleason score with the simpler Grade Group system, ranging from 1 to 5 .
Many medical centers report both the Gleason score and the Grade Group, but there may be some that still only report the old Gleason system.
Both systems attempt to communicate a variety of factors in a way that allows the medical team to communicate and compare cases and strategize treatments.
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The Importance Of Early Detection
Detecting prostate cancer at its earliest stage usually means better treatment outcomes.
Because of this, men must undergo DRE and PSA testing regularly. The age by which they need to start testing varies. But, if you have a very high risk of prostate cancer, due to family history and other risk factors, its important to consider testing at the age of 40.
Learn more about Prostate Cancer here.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still .
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
- Grade group: 1
- Gleason score: 6 or less
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What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
What Are Prostate Tests And How Is Prostate Cancer Diagnosed
Tests which check for prostate cancer include:
- A digital rectal exam . In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
- A prostate-specific antigen blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
- Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.
If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.
During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.
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What Questions Should I Ask My Healthcare Provider
Knowledge is power. If youve been diagnosed with cancer, youll want to gather as much information as you can. Here are some questions to ask your healthcare provider:
- What type of cancer do I have?
- Has the cancer spread to other areas of my body?
- What are my chances of survival?
- What treatments do you recommend?
- What are the risks and benefits of my treatment?
- How long will treatment take?
- Will I be able to work during cancer treatment?
- Will cancer treatment affect my fertility?
- Will I need to be hospitalized?
- Would a clinical trial be a good option for me?
A note from Cleveland Clinic
If youve been diagnosed with cancer, you may understandably feel sad, fearful or even angry. The good news is that there are plenty of resources available to help you cope, including support groups for nearly every type of cancer.
In addition, your healthcare provider can refer you to a counselor who can help you deal with the emotional aspects of your diagnosis. A social worker can also help you with the practical and financial issues related to the disease.
Undergoing cancer treatment can be a stressful journey. But your healthcare team can give you the resources you need to focus on healing and preserve your quality of life.
Last reviewed by a Cleveland Clinic medical professional on 09/08/2021.
Prostate Cancer Staging Systems
The predominantly used staging system for prostate cancer is the American Joint Committee on Cancer TNM system, which is a standard method for a cancer care team to describe how far a cancer has spread. To determine the stage of the prostate cancer, physicians evaluate the extent of the primary tumor , whether the cancer has spread to nearby lymph nodes , the absence or presence of distant metastasis , the PSA level at the time of diagnosis, and the Gleason score, based on the prostate biopsy .
There are actually two types of staging for prostate cancer, according to the American Cancer Society. The clinical stage is your doctors best estimate of the extent of your disease, based on the results of the physical exam , lab tests, prostate biopsy, and any imaging tests you have had. If you have surgery, your doctors can also determine the pathologic stage, which is based on the surgery and examination of the removed tissue. This means that if you have surgery, the stage of your cancer might actually change afterward .
Therefore, pathologic staging may be more accurate than clinical staging, since physicians can observe the extent of the cancer. This explains the advantages of radical prostatectomy surgery, when compared to radiation therapy or active surveillance.
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Tests To Identify Prostate Cancer Stage
After a prostate cancer diagnosis, your doctor will do tests to see how far the cancer has spread. Not all men need every test. It depends on the results of your biopsy, a test that checks tissue from your prostate gland for cancer. Tests that help your doctor figure out the stage of your prostate cancer include:
- CT scan of the abdomen and pelvis to see if the cancer has spread
- Nuclear medicine bone scan to see if the cancer has spread to your bones
- Surgery to check the lymph nodes in your pelvis for prostate cancer spread
How Prostate Cancer Spreads And Progresses
Prostate cancer grows within the prostate gland, often for many years. Over time, the cancer spreads outside the prostate. This happens in one of three ways:
- It grows into nearby tissues
- It spreads through your system of lymph nodes and lymph vessels
- It travels to distant tissues through your blood
Prostate cancer stages describe how far the cancer has spread.
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How Is The Stage Of Prostate Cancer Determined
A number of different tests are used to determine the stage of prostate cancer including:
- Screening tests including a:
A standardized staging system developed by the American Joint Committee on Cancer is the most commonly used staging system to help determine the stage of prostate cancer.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
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Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.