What Are the Five Stages of Prostate Cancer?

Staging is not the only information that doctors need. Symptoms and the patient’s age, life expectancy, co-existing health conditions and personal preferences may also be considered when deciding on treatment. Doctors use a general guideline (American Cancer Society, 2019) for treatment based on stage groups.

Stage I prostate cancer:

• Watchful waiting (tracking symptoms)
• Active surveillance (monitoring PSA levels)
• Radiation therapy (external beam or brachytherapy)
• Radical prostatectomy (removal of the prostate)

Stage II prostate cancer:

• Active surveillance
• Radiation therapy (external beam and/or brachytherapy)
• Radical prostatectomy
• Hormone therapy

Stage III prostate cancer:

• Radiation therapy with or without hormone therapy
• Radical prostatectomy

Stage IV and V prostate cancer:

• Hormone therapy with or without chemotherapy
• Radiation therapy and hormone therapy
• Radical prostatectomy
• Transurethral resection of the prostate (TURP)
• Treatments aimed at the site of metastasis, such as the bone
• Active surveillance
• Treatments to improve symptoms, such as pain or urinary difficulties (palliative care)

Prostate biopsy is done to screen for prostate cancers. This is to confirm whether cancer is present or if a prostate cancer diagnosis is aggressive. In a prostate biopsy, small samples of the prostate tissues are removed and then observed under a microscope. Doctors usually recommend a biopsy of the prostate gland based on certain findings, such as

• If prostate-specific antigen (PSA) blood test results are higher than average age.
• If the doctor detects signs of a prostate problem during a digital rectal exam (DRE).
• If magnetic resonance imaging (MRI) of the prostate is abnormal.
• If a biopsy is the only method to confirm cancer.

A prostate biopsy involves:

• Collecting minute samples of the prostate gland. A CT or MRI scan is also used to guide them through the procedure.
• A prostate biopsy takes about 10 minutes and is usually done in the doctor’s office. The samples will be sent to a lab and will be looked at under a microscope to see if they contain cancer cells.
• If cancer is detected in the patient, it will also be assigned a grade. The results are available after one to three days, but it can sometimes take longer.

A prostate biopsy may be done in several different ways, which may include

• The transrectal method is the most common approach. Biopsies are done using a transrectal ultrasound-guided (TRUS) technique. A TRUS prostate biopsy is where the needle goes through the wall of the back passage (rectum).
• The perineal method is done through the skin between the scrotum and the rectum.
• The transurethral method is a type of biopsy done through the urethra using a cystoscope (a flexible tube and viewing device).
• The transperineal biopsy requires a doctor to insert a needle into the prostate through the skin between the testicles and the anus. This area is called the perineum.
• Targeted biopsy uses advanced imaging techniques to identify cancerous areas and testing the identified areas. This can target a specific area of the prostate using MRI scans. An advantage of the targeted biopsy is that it is performed under local anesthesia.