Prostate Cancer Stages
If your doctor finds prostate cancer, your disease is “staged” according to international standards based on the Tumor, Nodes and Metastases Scale, or TNM scale. This helps gauge the severity of the disease and determine treatment options.
- In Stage T1, the tumor is only in the prostate gland, and your doctor can't feel it during the digital rectal exam.
- A Stage T2 tumors are also confined to the prostate gland, but your doctor can detect it with the digital exam.
- T3 tumors have spread from the prostate gland to surrounding tissues, including seminal vesicles.
- T4 tumors have spread outside of the prostate gland and into nearby organs, such as the bladder.
Nodes refer to the lymph node system, and indicates whether the cancer has spread to the lymph system (N+) or not (N0). Metastases are when the cancer has spread to distant parts of the body, such as the liver, brain or bones. M+ indicates that there are metastases (also known as “mets”), while M0 indicates that there is no evidence of metastases. For a more detailed overview of staging, please see Prostate Cancer Stages or Staging.
Each prostate cancer is also given a “grade,” known as a Gleason Score. This is determined by the pathologist who looks at the cancer cells within the tissue sample. For each area, the pathologist determines how aggressive the cancer appears, with 1 being the least aggressive and 5 being the most aggressive.
The Gleason score is the sum of the two most prominent Gleason patterns in the sample, with the most prominent score reported first. So, a Gleason score of 3+4 = 7 indicates a moderately aggressive cancer as the dominant pattern, with a slightly more aggressive cancer as the less dominant pattern. And, while the sum would still be 7, a 4+3 = 7 Gleason score would indicate a more aggressive prostate cancer than a 3+4=7. While this can be very confusing, it is very important to understand what your Gleason Score is and how it will impact your treatment options and your chance of reoccurrence. For a more detailed overview of Gleason, please see Gleason Grading of Prostate Cancer.