About this page. This is a plain English summary of how prostate cancer is "staged" once it has been diagnosed. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
What does "staging" mean?
Once a biopsy has confirmed prostate cancer, the next job is to work out how much of the prostate is affected and whether the cancer has spread anywhere else. This is called staging.
Staging is not about how aggressive the cancer looks (that is the Gleason score). It is about where the cancer is. Both pieces of information together help guide the right treatment.
The T stage: what the prostate feels like
The first part of staging happens at the time of the biopsy, when the urologist carefully feels the prostate. This gives the T stage (T stands for "tumour"):
- T1 - the cancer cannot be felt at all.
- T2 - a lump can be felt, but it appears to still be inside the prostate.
- T3 - the cancer can be felt to extend just beyond the prostate, but it is not stuck to anything around it.
- T4 - the cancer is attached to other structures, such as the bladder or the side wall of the pelvis.
This matters because, in many cases, a T3 cancer that still feels surgically removable can still be treated with surgery, while a T4 cancer is unlikely to be helped by surgery and is usually treated with radiotherapy instead.
Tests to check for spread
For very low-grade cancer these tests are often not needed. In most other cases, Dr Kooner organises:
- A bone scan. Prostate cancer most commonly spreads to bone, so this is the main test for bony spread.
- A CT scan of the abdomen and pelvis, mainly to check for enlarged lymph glands.
- A chest x-ray.
Other tests such as PSMA PET scans are sometimes used as well; the detailed page goes into the technical detail.
Putting it all together: the TNM stage
The results are written down as a TNM stage:
- T - the tumour stage (T1 to T4, as above).
- N - the lymph nodes. N0 means no lymph nodes are involved; N1 means at least one is.
- M - distant spread (metastases). M0 means no spread; M1 means there is spread, most often to bone.
The TNM stage, together with the Gleason score and the PSA, is what your specialist uses to recommend a treatment.
Important things to know
- Scans are very useful, but they are not perfect. Small areas of spread can be missed, and some scan findings turn out not to be cancer.
- The clinical T stage is what the urologist can feel; sometimes the surgical specimen later shows the cancer was a little more or less extensive than expected.
- Staging is one part of the picture. The Gleason score, your PSA, your age, and your other health issues all matter when choosing a treatment.
- A higher stage does not always mean a poorer outcome. Many men with locally advanced prostate cancer (T3) do very well with the right combination of treatments.
What you can do next
- Read the full detailed page with references.
- Short version: the Gleason score, which sits alongside staging.
- Short version: treatment options.
- Short version: dealing with a new diagnosis.
- Request a second opinion on staging and treatment.
- Call 02 8382 6980 to make an appointment.