What Are the Five Stages of Prostate Cancer?

The Gleason grading system grades prostate cancer from 1 to 5.
The Gleason grading system grades prostate cancer from 1 to 5.

The Gleason grading system grades prostate cancer from 1 to 5. According to cells’ appearances under a microscope, this system grades the most common (primary) and second most common (secondary) patterns of cells in a tissue sample collected via biopsy.

  • Grade 1: The cells appear like normal prostate cells.
  • Grades 2-4: Cells that score the lower look closest to normal and are suggestive of less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
  • Grade 5: Most cells look vastly different from normal.

Depending on the Gleason score, the American Joint Committee on Cancer (AJCC) has classified prostate cancer into four stages.

Stage I cancer:

  • This stage is known as localized cancer because the cancer has been found in only one part of the prostate (either half).
  • Stage I cancers cannot be felt during a digital rectal exam or seen with imaging tests.
  • If the prostate-specific antigen (PSA) is less than 10, it is most likely slow growing.

Stage II cancer:

  • This stage of cancer is still localized but is more advanced than stage I.
  • In stage II, the cells are less normal than stage I and may grow more rapidly.
  • Stage IIA means that the cancer is found only on one side of the prostate, whereas stage IIB means that the cancer is found in both sides of the prostate.

Stage III cancer:

  • This stage of cancer is called locally advanced prostate cancer.
  • It means the cancer has spread outside the prostate into local tissue, such as the seminal vesicles (the glands that make semen).
  • Stage III is subdivided into IIIA and IIIB depending on the local spread.

Stage IV cancer:

  • The tumor may have spread to nearby lymph nodes, but it has not spread to other parts of the body.
  • Stage IV is divided into IVA and IVB depending on the distant spread to the lymph nodes and surrounding organs.

To summarize:

  • Stages I and II are known as early (localized) prostate cancer
  • Stage III is known as locally advanced prostate cancer.
  • Stage IV is known as advanced (metastatic) prostate cancer.

What are the possible treatment options for 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:

Stage II prostate cancer:

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)


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Why is a prostate biopsy done?

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.
WebMD. What Is a Prostate Biopsy? https://www.webmd.com/prostate-cancer/what-is-prostate-biopsy#1

American Cancer Society. Prostate Cancer Stages and Other Ways to Assess Risk. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html