Staging and Grading
Doctors are continually searching for methods to determine how aggressive a given prostate cancer is in an individual patient so they can choose the best treatments. As an aid, experts have devised different classification systems that help assess the properties of the cancer. These systems include staging and grading the tumors and measuring PSA levels. In general, the higher the stage, grade, and PSA numbers, the more severe the condition and the more aggressive the treatment. Current classifications systems have significant limitations in guiding treatment choices. Newer tests, markers, and imaging techniques may eventually improve the accuracy of staging categories.
Staging Systems
A tumor's stage is an indication of how far it has spread from its original site. Cancers are staged according to whether they are still localized (still within the prostate gland) or have spread beyond the original site. Two prostate cancer staging systems are commonly used: the TNM system and the Jewett system. To avoid confusion, this report only uses the TNM system. The TNM system is explained in detail, and the Jewett system is explained in reference to the TNM system.
TNM Staging System
The TNM system refers to clinical tumor stages as:
T for tumor.
N for regional lymph nodes.
M for metastasis (tumors developing outside the prostate).
T Stages
T followed by numbers 0 through 4 refers to the size and extent of the tumor itself.
Stage |
Description |
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T1 |
The tumor cannot be felt or seen using imaging techniques. |
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T1a. Cancer cells are incidentally found in 5% or less of tissue samples from prostate surgery unrelated to cancer. |
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T1b. Cancer cells found in more than 5% of samples. |
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T1c. Cancer cells identified by needle biopsy, which is performed because of high PSA levels. |
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T2 |
The cancer is confined to the prostate but can be felt as a small well-defined nodule. |
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T2a. Tumors are in half a prostate lobe. |
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T2b. Tumors are in more than half a lobe. |
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T2c. Tumors in both lobes. |
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T3 |
The tumor extends through the prostate capsule. |
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T4 |
The tumor is fixed to or invades adjacent structures. |
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