The Four Prostate Cancer Stages

Key takeaways:

• The four main prostate cancer stages are determined by Gleason score and TNM staging system.
• Prostate cancer is curable if detected at an early stage.
• The early-stage survival rate is 100%, while the late-stage survival rate is 31%.
• Routine screenings for prostate cancer could help to catch it early.

This past winter, I went back to my hometown in France. I managed to have a one-on-one with my closest friends while masked and distanced to protect us both from COVID-19.

This year, the central theme of our discussions was prostate cancer. My friends’ dad was diagnosed with prostate cancer two years ago at 65 years old. The tumor was discovered at an early stage thanks to the active surveillance he started 10 years earlier.

Prostate cancer is something that all men worry about. However, knowledge is power, so let us teach you the four prostate cancer stages and how to detect prostate cancer early.

In this post, you will learn how to recognize the signs and common symptoms of each stage of prostate cancer and how a screening routine can help you detect prostate cancer at a treatable stage.

What Is Prostate Cancer?

The prostate gland is an organ involved in male reproduction. Its primary role is to secrete seminal fluid to give sperm an optimal environment to survive in and travel through during ejaculation. The prostate is located just in front of the bladder, around the urinary tract.

Prostate cancer is dysregulation of the prostate tissue’s division. Cancer cells proliferate indefinitely, and as the tumor grows, it puts pressure on the nearby tissues and organs. This disturbs their normal function.

What Are the Different Prostate Cancer Stages?

Following the tumor’s development, its progression is divided into four prostate cancer stages, from stage I (early stage) to stage IV (advanced prostate cancer). Doctors use specific metrics to categorize them.

There are two prostate cancer staging systems:

1. The Gleason Score

Gleason score is a grading system used to determine how aggressive your prostate cancer is and to classify the prostate cancer stages. Each patient biopsy sample receives two scores: one for the cells observed in the largest tumor area and one assigned to the second-largest tumor area.

• Based on an analysis of an individual prostate biopsy region, the Gleason score system assigns a score between 1 to 5.
• A score of 1 indicates well-differentiated cells (no cancer), while a score of 5 shows poorly differentiated cells and a lack of gland tissue (advanced cancer).
• An individual Gleason score of 3 or higher means cancer.
• The scores of the two biopsy regions that represent the predominant cancer cell populations give us a better idea of the tumor’s progression.
• The sum of the two Gleason scores ranges from 6 to 10.

The Gleason score is essential when evaluating prostate cancer behavior, but other factors like prostate-specific antigen (PSA) levels play a role in the diagnosis.

2. The TNM Staging System

TNM stands for tumor, node, and metastasis, which the system evaluates.

The American Joint Committee on Cancer (AJCC) and the International Union Against Cancer adopted the TNM system to help oncologists identify cancer stages and provide an appropriate treatment plan.

The TNM system takes the Gleason score and the blood’s PSA level into consideration. Here’s how the scores break down:

• Stage I (PSA <10 ng/mL, Gleason ≤6) is usually silent and does not require any treatment options other than active surveillance. This stage is not considered as cancer.
• Stage II (PSA ≥10 <20 ng/mL, Gleason ≤6), IIb ( PSA <20 ng/mL, Gleason 7), IIc ( PSA <20 ng/mL, Gleason 8) is considered cancer. As with stage I, the first approach is to wait and watch. The decision to undergo radical prostatectomy is made based on age and the desire to be treated.
• Stage III (any PSA, Gleason 6-8 or 9). The clinical-stage is considered advanced. Imaging tests are usually necessary to check on the distant lymph nodes and other distant organs like bone, liver, and lungs. Patients with stage III prostate cancer receive external-beam radiation therapy (EBRT) with or without hormonal treatment and ablation of one-half of the entire prostate.
• Stage IV (any PSA, any Gleason) is the most advanced of prostate cancer stages. In this case, the metastasis has spread to the bone. Hormonal and chemotherapy is necessary, as well as EBRT and palliative radiation therapy. Despite all the therapeutic efforts, the chance of survival at this stage is only 31%.

What Are the Symptoms of Prostate Cancers?

The symptoms of prostate cancer depend on the cancer’s stage.

For early stages (stages I and II), signs or symptoms are usually not perceptible. However, during advanced stages (stages III and IV), you may experience:

• Trouble urinating
• Intermittent stream of urine
• Blood in the urine or the semen
• Bone pain
• Lost weight without trying
• Erectile dysfunction

In any case, don’t wait for symptoms to appear. When detected at an early stage, the chances of surviving prostate cancer are nearly 100%.

How Early Can You Detect Prostate Cancer?

Age is the leading risk factor for developing prostate cancer. That means the earlier you start screening, the better chance you have of detecting it early.

Men who are age 50 and older and average risk should consider having prostate cancer screenings, according to the American Cancer Society. However, screening decisions should begin sooner for high-risk men who are at least 40-years-old.

Before planning your prostate screenings, it’s important to assess your risk level. Here are the factors to consider:

• Age: If you are a man who’s at least 50 years old, your risk of developing prostate cancer begins to increase every year.
• Ethnicity: African-American and Caribbean men with African ancestry are at a higher risk than other ethnicities. They tend to develop prostate cancer at a younger age.
• Geography: Populations in North America, Northwestern Europe, and Australia are at a higher risk level.
• Family history: If you have a prostate cancer case amongst your siblings or parents, your own risk increases.
• Obesity: Your risk of prostate cancer increases if you are obese.

What Screening Tests Are Available?

If you are a man over the age of 50 or at risk of developing prostate cancer, your primary care practitioner may prescribe one or more of these screening tests:

1. PSA level

Blood work will measure your PSA level. A concentration of 0.6 to 0.7 ng/ml is considered normal in 40 to 50-year-old men. However, an increase above 0.7 ng/ml will raise concerns about cancer.

While the PSA test is the most common test used to detect prostate cancer, studies showed it is not the most accurate. An estimated 70% to 80% of men with high PSA concentration don’t have cancer.

2. Digital rectal exam (DRE)

The DRE is a test performed at your doctor’s office. Your PCP will palp your prostate gland by inserting a gloved and lubricated finger into your rectum. If palpable, your prostate cancer could already be at stage II. TNM scoring of the biopsy will rule out any suspicion of cancer.

3. Imaging tests

Besides PSA level and DRE exams, your doctor may direct you to non-invasive imaging tests exams:

• A CT scan is an imaging tool that uses X-ray radiation to see inside your body. Your doctor may prescribe a CT scan to tell if your cancer has spread into nearby lymph nodes.
• An MRI scan will generate detailed images of your prostate using magnetic fields and radio waves. This technique can help to identify where to insert the needle biopsy if one is needed. Doctors could also use it to determine the extent of cancer in seminal vesicles or other parts of the body if needed. An MRI is usually preferred over a CT scan because it does not use radiation.
• A bone scan is generally performed in the case of advanced cancer. A bone scan can show if a cancer has reached the bone, which might explain bone pain symptoms.

Ezra Can Help You Prepare

To make an informed decision about undergoing a routine screening of your prostate, talk to your doctor. You can also take the ezra Know Your Risk questionnaire to help give more information regarding your cancer risks.

An MRI of the prostate plus DRE or PSA tests can help provide a more detailed picture of your prostate’s health.

Ezra’s full-body MRI scans the prostate plus 12 other organs. Learn more here about how we compare with other techniques and book your scan today.