Prostate Cancer Stages and Grade

This page is for anyone who has been told they have prostate cancer, or who is helping someone who has. It explains stage, grade, the Gleason score, and how they guide treatment.

Prostate cancer is described in two ways: its stage and its grade. Stage tells how far the cancer has spread. Grade tells how aggressive the cancer cells look. Both matter, because some prostate cancers grow so slowly they can be watched instead of treated right away.

Staging looks at whether the cancer is confined to the prostate, has grown just outside it, or has spread to lymph nodes (small bean-shaped glands) or distant sites such as bone.

• Stage I: a small, low-grade cancer confined to the prostate.
• Stage II: cancer still found in the prostate only, with a higher PSA or grade than stage I. It is divided into IIA, IIB, and IIC.
• Stage III: the cancer has grown outside the prostate, into the seminal vesicles (glands that help make semen) or nearby tissue. A very high PSA (at least 20) or the highest grade (Grade Group 5) can also make a cancer stage III.
• Stage IV: the cancer has reached nearby lymph nodes (stage IVA) or has spread to distant sites such as bone (stage IVB).

The grade reflects how aggressive the cancer cells look under a microscope. Pathologists (doctors who study tissue under a microscope) give a Gleason score, from 6 to 10, based on the two most common patterns of cells seen in the biopsy. A simpler system, called the Grade Group, translates this into a number from 1 to 5. Grade Group 1 is a Gleason score of 6 or less. Higher groups mean more aggressive cancer, and Grade Group 5 is the highest. NCI notes that the higher the Gleason score, the more likely the cancer is to grow and spread quickly.

Stage tells how far it has spread; grade tells how aggressive it looks.

PSA (prostate-specific antigen) is a protein made by the prostate. Its level in the blood is considered alongside stage and grade. In NCI's staging, a PSA under 10 fits stage I, a PSA of 10 to under 20 can fit stage IIA, and a PSA of 20 or more can fit stage IIIA. Doctors use PSA together with stage and Gleason score or Grade Group to sort cancers into overall risk categories, which then guide treatment choices.

Active surveillance means closely following the cancer and giving treatment only if test results change. NCI describes it as an option for older men with no symptoms or other medical conditions, and for men whose cancer was found by a screening test. Your team will tell you whether it fits your case. Other cancers are treated, for example with surgery or radiation. Hormone therapy may be added, because male sex hormones can make prostate cancer grow and hormone therapy lowers them.

NCI lists the tests as a digital rectal exam (a doctor feels the prostate with a gloved finger), a PSA blood test, transrectal ultrasound, and transrectal needle biopsy. The aim is to spot any growth of the cancer so treatment can start if it does. Ask your team which tests you will have and how often.

• What is my prostate cancer's stage?
• What is my Gleason score or Grade Group?
• What does my PSA level mean combined with these results?
• Is active surveillance a reasonable option for me, or does my risk category call for treatment now?

• National Cancer Institute — Prostate Cancer Treatment (PDQ) Patient Version