Following a prostate cancer diagnosis, staging is used to describe the extent of the disease. Prostate cancer staging is vital because it is used to guide the treatment plan and predict the patient’s prognosis.

Clinical Stages

The clinical stage is based on the results of the urologist's physical examination of the patient's prostate (including a digital rectal exam (DRE)) and any other tests done prior to definitive treatment (i.e., surgery or radiation).

The following clinical stages are used to describe prostate cancer:

• T1: The tumor cannot be felt during the DRE or  seen during imaging (e.g., a computed tomography (CT) scan or transrectal ultrasound). It may be found when surgery is done for another medical condition.
  • T1a: The tumor is discovered accidentally during a surgical procedure used to treat benign prostatic hyperplasia (BPH), which is the abnormal growth of benign prostate cells. Cancer is only found in 5 percent or less of the tissue removed.
  • T1b: The tumor is found accidentally during BPH surgery. Cancer cells are detected in more than 5 percent of the tissue removed.
  • T1c: The tumor is found during a needle biopsy that was performed because of an elevated PSA level.
• T2: The tumor appears to be confined to the prostate. Due to the size of the tumor, the doctor can feel it during the DRE. The cancer may also be seen with imaging.
  • T2a: The tumor has invaded one-half (or less) of one side of the prostate.
  • T2b: The tumor has spread to more than one-half of one side of the prostate, but not to both sides.
  • T2c: The cancer has invaded both sides of the prostate.
• T3: The tumor has grown outside the prostate. It may have spread to the seminal vesicles.
  • T3a: The tumor has developed outside the prostate; however, it has not spread to the seminal vesicles.
  • T3b: The tumor has spread to the seminal vesicles.
• T4: The tumor has spread to tissues next to the prostate other than the seminal vesicles. For example, the cancer may be growing in the rectum, bladder, urethral sphincter (muscle that controls urination) and/or pelvic wall.

Pathologic Staging

Following surgery to remove the prostate gland, a pathologist will assign the Gleason score and stage. The pathologist uses the TNM Staging System to describe how far the prostate cancer has spread. This system describes the tumor (T), lymph node (N) and metastasis (M) to lymph nodes and/or bones or other organs.

For T categories, please refer to the clinical stages section of this page. N0 indicates that the tumor has not spread to nearby lymph nodes while N1 means that it has. M0 means that the cancer has not spread to other areas of the body beyond nearby lymph nodes. M1 indicates that the cancer has spread to distant parts of the body, including distant lymph nodes (M1a), bones (M1b) and organs such as the liver, brain or lungs (M1c).

Partin Nomogram

Your doctor may use the Partin tables to predict your pathologic stage. The new Partin nomogram defines pathologic stages as:

• Organ-confined (OC) prostate cancer: This describes cancer found within the prostate gland.
• Extracapsular extension (ECE) orextraprostatic extension (EPE):Thetumor has broken through the capsule of the prostate gland. It may or may not be operable.
• Seminal vesicle (SV): The tumor has spread to the seminal vesicles adjacent to the prostate.
• Lymph nodes (LN): The tumor has spread to the lymph nodes near the prostate gland.

Knowing the stage of prostate cancer can help to determine how aggressively it needs to be treated and how likely it is to be removed by the available treatment options.