Stage grouping
Stage grouping
Once the T, N, and M categories have been determined, this information is combined, along with the Gleason score and PSA level, in a process called stage grouping. If the Gleason score or PSA results aren’t available, the stage can be based on the T, N, and M categories. The overall stage is expressed in Roman numerals from I (the least advanced) to IV (the most advanced). This is done to help determine treatment options and the outlook for survival or cure (prognosis).
Stage 1:
One of the following applies
T1, N0, M0, Gleason score 6 or less, PSA less than 10
The doctor can’t feel the tumour or see it with an imaging test such as trans-rectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10.
OR
T2a, N0, M0, Gleason score lower than 6, PSA less than 10:
The tumour can be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound and is in one half or less of only one side (left or right) of the prostate [T2a]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10.
Stage 2A:
One of the following applies
T1, N0, M0, Gleason score of 7, PSA less than 20
The doctor can’t feel the tumour or see it with imaging such as trans-rectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA level) [T1]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour has a Gleason score of 7. The PSA level is less than 20.
OR
T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20
The doctor can’t feel the tumour or see it with imaging such as trans-rectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour has a Gleason score of 6 or less. The PSA level is at least 10 but less than 20.
OR
T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
The tumour can be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound and is in only one side of the prostate [T2a or T2b]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. It has a Gleason score of 7 or less. The PSA level is less than 20.
Stage 2B:
One of the following applies
T2c, N0, M0, any Gleason score, any PSA
The tumour can be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound and is in both sides of the prostate [T2c]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.
OR
T1 or T2, N0, M0, any Gleason score, PSA of 20 or more
The cancer has not yet spread outside the prostate. It may (or may not) be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score. The PSA level is at least 20.
OR
T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA
The cancer has not yet spread outside the prostate. It may (or may not) be felt by digital rectal exam or seen with imaging such as trans-rectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 8 or higher. The PSA can be any value.
Stage 3:
One of the following applies
T3, N0, M0, any Gleason score, any PSA
The cancer has grown outside the prostate and may have spread to the seminal vesicles [T3], but it has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.
Stage 4:
One of the following applies
T4, N0, M0, any Gleason score, any PSA
The cancer has grown into tissues next to the prostate (other than the seminal vesicles), such as the urethral sphincter rectum, bladder, and/or the wall of the pelvis [T4]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumour can have any Gleason score and the PSA can be any value.
OR
Any T, N1, M0, any Gleason score, any PSA
The tumour may or may 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 tumour can have any Gleason score and the PSA can be any value.
OR
Any T, any N, M1, any Gleason score, any PSA
The cancer may or may not be growing into tissues near the prostate [any T] and may or may not have spread to nearby lymph nodes [any N]. It has spread to other, more distant sites in the body [M1]. The tumour can have any Gleason score and the PSA can be any value.
References
- Cansa.org. Fact Sheet on Prostate Cancer. https://cansa.org.za/files/2021/04/Fact-Sheet-on-Prostate-Cancer-NCR-2017-web-March-2021.pdf. Accessed on 22 October 2021.
- American Cancer Society. Initial Treatment of Prostate Cancer, by Stage and Risk Group. https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html. Accessed on 22 October 2021.
- American Cancer Society. Prostate Cancer Stages. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html. Accessed on 22 October 2021.
- National Cancer Institute. Stages of Prostate Cancer. https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#_120. Accessed on 22 October 2021.