These tests help your doctors work out whether you have prostate cancer and whether it has spread. This process is called staging. It helps you and your health care team decide which management or treatment option is best for you.
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Staging prostate cancer
The most common staging system for prostate cancer is the TNM system. In this system, letters and numbers are used to describe the size of the tumour (T), whether the cancer has spread to nearby lymph nodes (N), and whether the cancer has spread to the bones or other organs, i.e. whether it has metastasised (M). The TNM scores are combined to work out the overall stage of the cancer, with higher numbers indicating larger size or spread.
| localised (early) | stages 1–2 | The cancer is contained inside the prostate. |
| locally advanced | stage 3 | The cancer is larger and has spread outside the prostate to nearby tissues or nearby organs such as the bladder, rectum or pelvic wall. |
| advanced (metastatic) | stage 4 | The cancer has spread to distant parts of the body such as the lymph glands or bone. This is called prostate cancer even if the tumour is in a different part of the body. |
Grade and risk category
The biopsy results will show the grade of the cancer. This is a score that describes how quickly the cancer may grow or spread.
For many years, the Gleason scoring system has been used to grade the tissue taken during a biopsy. If you have prostate cancer, you’ll have a Gleason score between 6 and 10. A new system has been introduced to replace the Gleason system. Known as the International Society of Urological Pathologists (ISUP) Grade Group system, this grades prostate cancer from 1 (least aggressive) to 5 (most aggressive).
Risk of progression
Based on the stage, grade and your PSA level before the biopsy, localised prostate cancer will be classified as having a low, intermediate or high risk of growing and spreading. This is known as the risk of progression. The risk category helps guide management and treatment.
Grading prostate cancer
| Grade Group | Gleason | Risk group |
| 1 | 6 or less | Low risk. The cancer is slow growing and not aggressive. |
| 2–3 | 7 | Intermediate risk. The cancer is likely to grow faster and be mildly to moderately aggressive. |
| 4–5 | 8–10 | High risk. The cancer is likely to grow aggressive. |
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.
To work out your prognosis, your doctor will consider test results, the type of prostate cancer, the stage, grade and risk category, how well you respond to treatment, and factors such as your age, fitness and medical history.
Prostate cancer often grows slowly, and even the more aggressive cases of prostate cancer tend to grow more slowly than other types of cancer. Compared with other cancers, prostate cancer has one of the highest five-year survival rates if diagnosed early. Some low-risk prostate cancers grow so slowly that they never cause any symptoms or spread.
Dr Amy Hayden, Radiation Oncologist, Westmead and Blacktown Hospitals, and Chair, Faculty of Radiation Genito-Urinary Group (FROGG), The Royal Australian and New Zealand College of Radiologists, NSW; Prof Shomik Sengupta, Professor of Surgery and Deputy Head, Eastern Health Clinical School, Monash University, and Visiting Urologist and Uro-Oncology Lead, Urology Department, Eastern Health, VIC; A/Prof Arun Azad, Medical Oncologist, Urological and Prostate Cancers, Peter MacCallum Cancer Centre, VIC; Ken Bezant, Consumer; Dr Marcus Dreosti, Radiation Oncologist, GenesisCare, and Clinical Strategy Lead, Oncology Australia, SA; A/Prof Nat Lenzo, Nuclear Physician, Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics and The University of Western Australia, WA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, and HeadwayHealth Clinical and Consulting Psychology Services, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia; Graham Rees, Consumer; Kerry Santoro, Prostate Cancer Specialist Nurse, Southern Adelaide Local Health Network, SA; A/Prof David Smith, Senior Research Fellow, Cancer Research Division, Cancer Council NSW; Matthew Starr, Consumer. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title. This booklet is funded through the generosity of the people of Australia.
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