Prostate Cancer Stages Explained: What You Need to Know

The Four Stages of Prostate Cancer

Prostate cancer spreads through different stages, where each stage is defined by the aggressiveness and extent to which it has spread. Knowing these stages can be helpful in deciding treatment and prognosis.

Stage I: Early and Localized Cancer

At this stage, the cancer is still small and on the one side of the prostate.

Key Characteristics:

• The cancer cannot be felt during a digital rectal exam (DRE)
• The level of PSA is less than 10 ng/mL
• Gleason score is 6 or less
• There is no sign of cancer in lymph nodes or spreading.

Symptoms:

At this stage, there are no symptoms and the cancer is found by accident during a routine PSA screening or a biopsy.

Treatment Options:

• Active Surveillance – Regular testing with PSA and biopsies, mostly advised for patients with low risk
• Radical Prostatectomy – The surgery that removes the prostate gland
• Radiation Therapy – The case of external beam or brachytherapy in chosen instances

Prognosis:

The five-year survival rate is almost 100%, which makes this the stage with the highest cure rate.

Stage II: More Advanced but Still Localized

The second stage of cancer in the prostate is still confined to the gland but the cancer may have spread to the other side of the prostate.

Key Characteristics:

• PSA value is less than 20 ng/mL
• The Gleason score is from 6 to 8
• The tumor can be felt during DRE or can be seen in an imaging method

Symptoms:

Most patients do not have any symptoms, however, some patients may see the following:

• Frequent urination, especially at night
• Very weak urine flow
• Hard to start urination

Treatment Options:

• Prostatectomy with Lymph Node Removal – Typical for healthy and young patients
• Radiation Therapy – It may be external beam or seed implant (brachytherapy)
• Hormone Therapy – May be allowed with radiation for the higher-risk Stage II cases
• Active Surveillance – Applicable to Stage IIA and certain Stage IIB patients with very slow tumor growth

Prognosis:

With the right and on-time treatment, the survival rate is almost 100%.

Stage III: Locally Advanced Cancer

The stage III cancer has infiltrated the area outside of the prostate capsule and is next to the tissues. It can involve seminal vesicles but lymph nodes or distant organs are not affected.

Key Characteristics:

• PSA can go up to 20 ng/mL or more
• Gleason score is usually 8 or higher
• The tumor is still growing and has infiltrated the surrounding tissues

Symptoms:

• Frequent urination and urgency
• Pelvic discomfort or a feeling of heaviness in the area
• Erectile Dysfunction
• There might be blood in the urine or semen (rarely)

Treatment Options:

• External Beam Radiation + Hormone Therapy – The treatment is the standard for most patients
• Combination Therapy – Surgery followed by radiation and/or hormone therapy
• Radiation Brachytherapy – Patient can also receive external radiation along with it

Stage IV: Advanced and Metastatic Cancer

Stage IV is the terminal stage, where the cancer has metastasized into far away lymph nodes, bones, or other organs.

Key Characteristics:

• The bladder, rectum, or pelvic wall area can be involved
• Extended to the bones, liver, or lungs
• Any PSA level or Gleason score can be present

Symptoms:

• Bones pain (hips, spine, ribs)
• Great urinary problems
• Tiredness and unexplained loss of weight
• If the spine is involved, there may be numbness or weakness in the legs

Treatment Options:

• Hormone Therapy – Testosterone is lowered to decrease the cancer growth rate
• Chemotherapy – Used when the cancer is resistant to hormones
• Radiation Therapy – The method employed to alleviate the patient’s suffering or to control metastasis in bones
• Immunotherapy & Clinical Trials – Aimed at the most advanced or resistant cases

Prognosis:

Though Stage IV prostate cancer is not generally curable, the treatment is aimed at cancer control, symptom alleviation, and enhancing the quality of life.