Staging and prognosis for prostate cancer

Once you have had tests that show you have prostate cancer and whether it has spread, your doctor will assign a staging and grading category to your cancer. This staging helps you and your health care team decide the best treatment or management option for you.

The expected outcome of your disease is called the prognosis, but it is only a prediction and some men do not find it helpful or even prefer not to know.

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Staging prostate cancer

Staging determines the extent of the cancer and whether it has spread from the original site to other parts of the body. The cancer may be described as one of the following:

  • Localised – the cancer is contained within the prostate.
  • Locally advanced – the cancer is larger and has spread outside the prostate to nearby tissues or organs near the prostate such as the bladder, rectum or pelvic wall.
  • Metastatic – the cancer has spread to distant parts of the body such as the lymph glands or bones, or secondary tumours have developed away from the primary tumour. This is called prostate cancer even if the tumour is in a different sort of tissue.

TNM system

This system is used to stage prostate cancer. Each letter is assigned a number that shows how advanced the cancer is. The lower the number, the less advanced the cancer. The scores are combined to describe the stage of the cancer from stage 1 to stage 4.

  • T (Tumour) 0–4 – Refers to the extent of the primary tumour. The higher the number, the less likely the cancer is confined to the prostate gland.
  • N (Nodes) 0–3 – Shows whether the cancer has spread to the regional lymph nodes near the bladder. No nodes affected is 0; increasing node involvement is 1, 2 or 3.
  • M (Metastasis) 0–1 – Indicates whether the cancer has spread (metastasised) to the bones or other organs (1) or it hasn’t (0).

Grading prostate cancer

Grading describes how aggressive the cancer cells are. This is determined by a pathologist, who looks at the cells under a microscope.

  • Low-grade cancer cells – tend to grow slowly
  • High-grade cancer cells – look abnormal and grow quickly

Grading systems

For many years, the Gleason scoring system has been used for grading the tissue taken during a biopsy. All men with prostate cancer will have a Gleason score between 6 and 10. Your doctor will also consider how much cancer there is (its volume). For example, if you have one small area of cancer, your doctor would consider this a low-volume cancer. If you have a low-volume cancer that is also low grade, you might choose to have less aggressive management or treatment such as active surveillance. 

From 2016, the International Society of Urological Pathology or ISUP score will be gradually introduced. This ISUP score grades cancer from 1 (least aggressive) to 5 (most aggressive).

  • Low (suggests a slow-growing, less aggressive cancer) – Gleason 6, ISUP 1
  • Intermediate (may indicate a faster-growing and moderately aggressive cancer) – Gleason 7, ISUP 2–3
  • Higher (indicates an aggressive cancer) – Gleason 8–10, ISUP 4–5

Prognosis

Prognosis means the expected outcome of a disease. Generally, prognosis is better when prostate cancer is diagnosed while it is early stage, and at a lower grade.

You will need to discuss your prognosis with your doctor. However, it is not possible for any doctor to predict the exact course of the cancer.

Factors used to assess prognosis include:

  • test results
  • the extent of the spread 
  • your age, level of fitness, medical and family history.

These factors will also help your doctor advise you on the best management or treatment options and tell you what to expect.

Prostate cancer often grows slowly, and even the more aggressive prostate cancers 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. For many men, the prostate cancer grows so slowly that it never needs treatment. Many men live with prostate cancer for many years without any symptoms and without it spreading.

For men diagnosed with localised prostate cancer, risk of progression may be categorised as low, intermediate or high. The risk is determined by combining biopsy grading, clinical staging and pre-biopsy PSA along with overall health, age and wishes, to work out the most appropriate course of management or treatment.


This information was last reviewed in April 2016
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