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Prostate cancer staging

Definition

Cancer staging is a way to describe how much cancer is in your body and where it is located. Prostate cancer staging is determined by how big your tumor is, whether it has spread, and where it has spread.

Knowing the stage of your cancer helps your cancer team:

• Decide the best way to treat the cancer

• Determine your chance of recovery

• Find clinical trials you may be able to join

How Prostate Cancer Staging is Done

Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.

PSA refers to a protein made by the prostate measured by a lab test.

• A higher level of PSA can indicate a more advanced cancer.

• Your health care provider will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.

A prostate biopsy is done in your urologist's office. The results can indicate:

• How much of the prostate is involved.

• The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.

Imaging tests such as a CT scan, MRI, or bone scan also may be done.

Using the results from these tests, your urologist can tell you your clinical stage. At times, this is enough information to make decisions about your treatment.

Surgical staging (pathological staging) is based on what your urologist finds if you have surgery to remove the prostate and perhaps some of the lymph nodes. Lab tests are done on the tissue that's removed.

This staging helps determine what other treatment you may need. It also helps predict what to expect after treatment ends.

What the Stages Mean

The higher the stage, the more advanced the cancer.

Stage I cancer. The cancer is found only in one part of the prostate. Stage I is called localized prostate cancer. It cannot be felt during a digital rectal exam or seen with imaging tests. If the PSA is less than 10 and the Gleason score is 6 or less, Stage I cancer is likely to grow slowly.

Stage II cancer. The cancer is more advanced than stage I. It has not spread beyond the prostate and is still called localized. The cells are less normal than cells in stage I, and may grow more rapidly. There are two types of stage II prostate cancer:

• Stage IIA is found in only one side of the prostate.

• Stage IIB may be found in both sides of the prostate.

Stage III cancer. The cancer has spread outside the prostate into local tissue. It may have spread into the seminal vesicles. These are the glands that make semen. Stage III is called locally advanced prostate cancer.

Stage IV cancer. The cancer has spread to distant parts of the body. It could be in nearby lymph nodes or bones, most often of the pelvis or spine. Other organs such as the bladder, liver, or lungs can be involved.

Staging along with the PSA value and Gleason score helps you and your provider decide on the best treatment, taking into account:

• Your age

• Your overall health

• Your symptoms (if you have any)

• Your feelings about side effects of treatment

• The chance that treatment can cure your cancer or help you in other ways

With stage I, II, or III prostate cancer, the main goal is to cure the cancer by treating it and keeping it from coming back. With stage IV, the goal is to improve symptoms and prolong life. In most cases, stage IV prostate cancer cannot be cured.

References

Eastham JA. Diagnosis and staging of prostate cancer. In: Dmochowski RR, Kavoussi LR, Peters CA, et al, eds. Campbell-Walsh-Wein Urology. 13th ed. Philadelphia, PA: Elsevier; 2026:chap 157.

National Cancer Institute website. Prostate cancer treatment (PDQ) health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated May 14, 2025. Accessed July 2, 2025.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): Prostate cancer. Version 2.2025. www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Updated April 16, 2025. Accessed July 2, 2025.

Nelson WG, Antonarakis ES, Carter B, De Marzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 81.

Review Date: 7/1/2025

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.