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If you have been diagnosed with prostate cancer, your doctor also needs to know the stage, or extent, of the disease.
Staging is an attempt to determine whether the cancer has spread and, if so, what areas of the body are affected. Various blood and imaging tests are used to learn the stage of the disease.
Treatment decisions are based on these findings. By knowing how the cancer is growing and exactly where it is located, you and your physician will be able to choose the best treatment for you.
There are several different systems used by health care professionals to describe stages of cancer. Each uses a classification scheme to reflect the progressive stages of the disease. In general, the different systems attempt to classify the stage of the cancer by evaluating the following:
- The size and location of the tumor
- Whether the cancer cells have moved beyond the tumor, but are still within a specific area or organ of the body
- Whether the cancer cells have spread beyond the specific area or organ of the body to other tissues beyond it
- Whether the cancer cells have spread into the lymph nodes
- Whether the cancer cells have metastasized into another part of the body
The most detailed prostate cancer staging system is called the TNM System and was developed by the American Joint Committee on Cancer. It classifies cancers according to size (T), the extent of spread to lymph nodes (N), and the extent of metastases to other parts of the body (M).
A brief outline of the stages of prostate cancer and the typical treatments provided at each stage follows:
- Stage I (also known as Stage A or Stage T1)
Description: The tumor is located within the prostate only. At this stage it does not cause any symptoms, and it is still too small to be felt during a DRE or to be seen on an imaging scan. Tumors at this stage are usually found by chance during surgery for a benign tumor or for some other prostate disease. They also may be found during follow-up screening tests that measure PSA.
Common treatment choices: Sometimes surgery or radiation therapy will be recommended at this stage. In other cases, no treatment is given. The patient and his physician may simply decided to wait and monitor the cancer and get regular DREs and blood tests. Treatment may be started later if necessary.
- Stage II (also known as Stage B or Stage T2)
Description: A tumor at this stage is still located only within the prostate. It is large enough to be felt during a DRE, but patients often do not experience any symptoms.
Common treatment choices: Treatment options for this stage often include surgery, radiation therapy, or hormone therapy.
- Stage III (also known as Stage C or Stage T3)
Description: At this stage the tumor has spread from the prostate into the immediately surrounding tissue. The seminal vesicles may be included.
Common treatment choices: Surgery, radiation therapy, or both are common choices during this stage. In addition, hormone therapy both before and after surgery or radiation therapy may be used.
- Stage IV (also known as Stage D2 or Stage M1)
Description: Distant metastasis (the tumor has spread beyond the pelvic area to other parts of the body), which can include the spinal column. Bone pain, weight loss, and tiredness are common symptoms.