Grading and Staging

What Is Staging In Prostate Cancer?

In developing a treatment plan, you and your doctor will discuss the advantages and disadvantages of each treatment option.

To detect and diagnose prostate cancer and to determine the size and extent of the spread - or stage - of the disease, your doctor may perform tests that involve feeling the prostate, looking at internal parts of the body, measuring the levels of substances in the blood, and examining samples of prostate cells. Specific tests are described here.

Why is it important for your doctor to determine the stage of your prostate cancer?

Only by knowing how the cancer is growing and exactly where it is located in the body can you and your doctor choose the best treatment for you. There are two commonly used systems to stage prostate cancer: T, N, M Staging and A, B, C, D, or Whitmore-Jewett Staging.

TNM Staging System

The most common method of staging prostate cancer is by using a system called the TNM staging system, which stands for Tumor, Node, Metastases. It is an international system that was developed by The American Joint Committee on Cancer.1 The table below describes the TNM Staging System in more detail.

T refers to the size of the primary tumor

N describes the extent of regional lymph node involvement

M refers to the presence or absence of metastases

In addition, the equivalent stages in the A, B, C, D, or Whitmore-Jewett staging system are given in parentheses in the table.

T Staging
Stage TX, T0, T1
TX Primary tumor cannot be assessed.
T0 No evidence of primary tumor.
T1 (A) Tumor not clinically apparent.
T1a (A1) Tumor incidentally found in <= 5% of prostate sample.
T1b (A2) Tumor incidentally found in > 5% of prostate sample.
T1c Tumor identified at needle biopsy performed to investigate PSA elevation.
Stage TX, T0, T1 		Stage T2
T2 (B) Palpable tumor confined to prostate.
T2a (B1N) Tumor involves less than half of one prostate lobe.
Stage T2b (B1)
T2b (B1) Tumor involves more than half of one lobe but not both lobes.
T2c (B2) Tumor involves both prostate lobes.
Stage T2c (B2)
Stage T3
T3
(C1 - tumor < 6 cm)
  Tumor palpable and extends beyond prostate capsule.
T3a (C1) Tumor extends beyond prostate capsule, either on one side (unilaterally) or both sides (bilaterally).
Stage T3a (C1)
T3b (C1) Tumor invades seminal vesicles.
Stage T3b (C1)

T Staging (con't) N Staging M Staging
Stage T4
T4
(C2-tumor > 6cm)
Tumor is fixed or invades adjacent anatomy other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall.
Stage T4 		Stage NX, N0, N1
NX Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1(D1) Metastasis in regional lymph node or nodes.
Stage N1 (regional lymph node involvement)
Stage MX, M0, M1
MX Presence of distant metastasis cannot be assessed.
M0 No distant metastasis.
M1 (D2) Distant metastasis.
M1a (D2) Metastasis to nonregional
lymph nodes.
M1b (D2) Metastasis to bone.
M1c (D2) Metastasis to other distant sites.
Stage M1b (bone metastases)
A bone scan image. Dark spots (“hot spots") represent an accumulation of radioactive material which may indicate the presence of bone metastases.

References:

  1. Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ eds. American Joint Committee on Cancer Staging Manual. 4th ed. New York, NY: Lippincott; 1992.