What are the different stages of prostate cancer?

Prostate cancer staging is a classification system that describes where the cancer is located and whether it has spread to other parts of the body.¹ Staging is essential for determining the extent of the disease, which helps guide treatment recommendations.²

The stages of prostate cancer are typically described using the Tumour, Node, Metastasis (TNM) system, which uses letters and numbers to describe key features of the cancer: the size and extent of the tumour (T0 to T4), the involvement of nearby lymph nodes (N0 or N1), and the presence of metastasis (M0 or M1).²

The extent of prostate cancer can also be described as localised or early (still within the prostate), locally advanced (spread outside the prostate but within the pelvis), or advanced or metastatic (spread to distant parts of the body).² Localised prostate cancer is also classified according to its risk for progression, reflecting the aggressiveness of the cancer, which uses information from a prostate biopsy (what the cancer cells look like under the microscope) and levels of prostate-specific antigen (PSA).²

Stage I: In Stage I prostate cancer, the tumour is present only inside the prostate but may not be detectable on imaging or examination by the doctor (T1), and it has not spread to nearby lymph nodes (N0) or distant sites (M0).^1,3

Stage II: Stage II prostate cancer is still localised to the prostate, but the tumour is larger in size (T2) and can be felt on examination (palpable). It may be on one or both sides of the prostate but with no lymph node involvement (N0) and no spread outside the pelvis (M0).^1,3

Stage III: In Stage III, the cancer has spread outside the prostate itself (on one or both sides; T3A) or into the seminal vesicles (T3B) or nearby tissues of organs such as the bladder, rectum, or pelvic wall (T4), but not to lymph nodes (N0) or distant sites (M0).^1,3

Stage IV: Stage IV prostate cancer is when the cancer has spread beyond the prostate to lymph nodes in the pelvis (N1) or to distant parts of the body, such as bones, lymph nodes, or other organs outside the pelvis (M1).^1,2

A range of treatment options are available for prostate cancer and will be recommended for each individual patient based on the stage and aggressiveness of their cancer, as well as their overall health and personal preferences.²

Treatment options for prostate cancer include:

• Active surveillance – This approach involves closely monitoring the cancer without immediate treatment. Regular check-ups, including PSA tests, MRIs and biopsies, help assess whether the cancer is progressing.²
• Surgery (prostatectomy) – This involves the surgical removal of the prostate gland and some surrounding tissue. It can be performed using traditional open surgery or minimally invasive techniques, such as laparoscopic or robotic-assisted surgery.²
• Radiation therapy – This uses high-energy rays to target and kill cancer cells. It can be delivered externally (external beam radiation) or internally (brachytherapy), where radioactive seeds are implanted in the prostate.²
• Hormone therapy – Also known as androgen deprivation therapy (ADT), this treatment reduces levels of male hormones (androgens) that fuel the growth of prostate cancer. It can involve medications or surgical removal of the testicles (orchiectomy).²
• Chemotherapy – This treatment uses drugs to kill rapidly dividing cancer cells.²
• Immunotherapy – This treatment uses medications to help the body's immune system recognise and attack cancer cells.⁴
• Targeted therapy – This treatment uses medications to interfere with specific features of the cancer cells to block their growth and spread.²

While treatment recommendations are made on an individual basis, some treatment options may be considered for certain stages of prostate cancer and not others. In general, treatment options for localised (early) prostate cancer may include active surveillance, surgery, or radiation therapy.² For locally advanced prostate cancer, treatment typically consists of surgery and/or radiation therapy and may include hormone therapy.²

Treating advanced (metastatic) prostate cancer typically involves hormone therapy, with other treatments including radiation therapy, chemotherapy, and targeted therapy, or combinations of these therapies, also used at this stage.²

More information on treatment options can be found here.

Remember, it's essential to talk with your doctor or specialist about prostate cancer treatment options, as they can provide personalised guidance and support tailored to your individual needs and circumstances.