Stages of Prostate Cancer

There are four different stages of prostate cancer, each with its own types of symptoms and recommended treatments.

If you or someone you know has just been diagnosed with prostate cancer, you might be wondering how serious it is. Prostate cancer has four different stages, and each stage has different symptoms, pathology, treatments and survival rates.  

“Prostate cancer is the most common cancer in men in the United States and the second most common cause of cancer-related deaths,” says Sij Hemal, MD, a urologic oncologist with USC Urology, part of Keck Medicine of USC. Around 12% of men in the U.S. will get this type of cancer, he says, which translates to 1 in every 8 men in the country, making the chances of knowing someone with this disease very common.  

“Staging of prostate cancer is very complex, involving clinical staging with rectal exams, MRI and pathological staging with prostate biopsy and blood test,” Dr. Hemal says. Another thing that can affect what stage of prostate cancer you have is metastasis, which is whether your cancer has spread to other parts of your body.  

Here are the symptoms and treatments for the four stages of prostate cancer: 

1. Stage I 

It’s a common misconception that early-stage prostate cancer causes symptoms. “Stage I prostate cancer does not cause symptoms,” Dr. Hemal says. It is typically measured with the help of a blood test known as a prostate-specific antigen (PSA) test, he says. If your PSA levels are found to be abnormal, a doctor will do a full diagnostic evaluation for prostate cancer.  

“Stage I is usually when the tumor of the prostate gland cannot be felt on a rectal exam, and the cancer is typically found because there was an abnormal elevation in your PSA and subsequently that led to a prostate biopsy which revealed the prostate cancer,” Dr. Hemal says. “Or it can be the case where an abnormal PSA caused doctors to order an MRI, and on that MRI there was an abnormal-looking lesion, which was biopsied afterwards and found to be prostate cancer.” 

2. Stage II 

“Stage II is when the tumor appears to be confined to the prostate gland, but due to the size of the cancer, it can be felt by the urologist on the rectal exam,” Dr. Hemal says. 

Most patients are diagnosed with either Stage I or Stage II, Dr. Hemal says, and this is mostly because more people are getting screened on a regular basis with PSA, so primary care doctors are catching prostate cancer earlier.  

3. Stage III 

Stage III is when the tumor has grown outside the prostate or is involving any accessory organs, such as the seminal vesicles, which run adjacent to the prostate gland and play an important part in liquefying semen.  

“If the cancer is growing outside of the prostate and invading the seminal vesicles or the nerves that run near the prostate, which are responsible for erections in men, it’s considered Stage III,” Dr. Hemal says. A cancer is additionally categorized as Stage III if it grows beyond the prostatic capsule or the border of the prostate gland.  

4. Stage IV 

“Stage IV is when the tumor has spread to tissues next to the prostate other than the seminal vesicles — for example, if the cancer is going into the rectum, back into the bladder or involving the pubic sidewall or the urethral sphincter, which is the muscle that controls urination,” Dr. Hemal says.  

Cancer is also considered Stage IV if it is metastatic, which means it has spread to other structures such as the lymph nodes, bones, lung or liver, he says.

“There are different survival rates for each stage of prostate cancer, but I do think prostate cancer is curable, especially when caught in the earlier stages from Stage I up to certain Stage III cancers,” Dr. Hemal says.  

What is a Gleason score? 

“The Gleason grading system is used for defining the biological aggressiveness of prostate cancers,” says Dr. Hemal. Doctors use this, in conjunction with the prostate cancer staging system, to determine what course of treatment will be best for you.  

“The Gleason grading system is a method for evaluating the prognosis of prostate cancer by analyzing tissue samples from a prostate biopsy,” says Dr. Hemal.    

To determine your Gleason score, a medical pathologist examines one of your tissue samples under a microscope to assess the arrangement and differentiation of the cancer cells. The pathologist then assigns a grade to each pattern of cancer cells, and your Gleason score is the sum of the two most common grades of the sample, Dr. Hemal says. For example, a Gleason score of 3+4=7 means that the most common grade is 3 and the second most common is 4.  

What does a Gleason score mean? 

The Gleason score indicates how likely the cancer is to spread and how it will respond to treatment. There are three types:   

1. Low-grade 
   A score of 6 or lower, which means the cancer grows slowly and is less likely to spread  

2. Medium-grade 
   A score of 3+4=7 or 4+3=7  

3. High-grade 
   A score of 8 or higher  

Why is the Gleason score important? 

The Gleason score is used in conjunction with other factors to stage prostate cancer, which helps guide therapy and predict your outcomes. 

“Higher grade prostate cancers that are the clinical Stage III cancers or pathologically the higher risk cancers (i.e. Gleason 8/9/10) may require additional multimodal treatment, such as surgery in combination with radiation and/or hormone therapy, due to the biological aggressiveness of certain prostate cancers,” Dr. Hemal says. 

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