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The stages of prostate cancer

The stage of a cancer tells the doctor how far the cancer has spread. It is important because knowing the stage helps doctors decide the best treatment.

You may hear your doctor talk about your cancer stage as TNM. This stands for Tumour, Nodes and Metastases. It is a detailed way of staging that tells the doctor the size of the tumour, whether there is cancer in nearby lymph nodes, and whether it has spread to anywhere else in the body. 

As well as using the TNM system, doctors group prostate cancers into 3 groups

  • Localised prostate cancer is cancer that is contained within the prostate gland
  • Locally advanced prostate cancer is cancer that has broken through the outer covering (capsule) of the prostate gland
  • Metastatic prostate cancer is cancer that has spread to other parts of the body

How prostate cancer spreads

Prostate cancer tends to spread to lymph nodes or bones rather than any other organs. With prostate cancer, it is sometimes possible for metastases (cancer spread) to be present even when the prostate tumour is still very small.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating prostate cancer section.

 

 

What staging is

The stage of a cancer tells the doctor how far the cancer has spread. The tests and scans you have when diagnosing your cancer give some information about the stage. It is important because knowing the stage helps doctors decide on which treatment you need.

 

TNM stages of prostate cancer

Prostate cancer is staged using the TNM system. This is used all over the world. It separately assesses the tumour (T), lymph nodes (N) and secondary cancer (metastases – M).

T (tumour) staging

T1 tumours are too small to be seen on scans or felt during examination of the prostate – they may have been discovered by needle biopsy, after finding a raised PSA level

T2 tumours are completely inside the prostate gland and are divided into 3 smaller groups

  • T2a – The tumour is in only half of one of the lobes of the prostate gland
  • T2b – The tumour is in more than half of one of the lobes
  • T2c – The tumour is in both lobes but is still inside the prostate gland

T3 tumours have broken through the capsule (covering) of the prostate gland but have not spread into other organs – they are divided into 2 smaller groups

  • T3a – The tumour has broken through the capsule (covering) of the prostate gland
  • T3b – The tumour has spread into the seminal vesicles

T4 tumours have spread into other body organs nearby, such as the rectum (back passage), bladder, muscles or the sides of the pelvic cavity

Diagram showing T1-3 stages of prostate cancer

Stage T3 and T4 tumours are referred to as locally advanced prostate cancer.

Diagram showing stage T4 prostate cancer

N (lymph node) staging

Lymph nodes are described as being 'positive' if they contain cancer cells. If a lymph node has cancer cells inside it, it is usually bigger than normal. The more cancer cells it contains, the bigger it will be.

  • NX – The lymph nodes cannot be checked
  • N0 – There are no cancer cells in lymph nodes close to the prostate
  • N1 – There are cancer cells present in lymph nodes

Diagram showing prostate cancer that has spread to the lymph nodes

M staging – metastases (cancer spread)

  • M0 – No cancer has spread outside the pelvis
  • M1 – Cancer has spread outside the pelvis
  • M1a – There are cancer cells in lymph nodes outside the pelvis
  • M1b – There are cancer cells in the bone
  • M1c – There are cancer cells in other places

Diagram showing prostate cancer that has spread to the bones

As well as using the TNM staging, doctors put prostate cancers into 3 groups.

 

Localised prostate cancer

Localised prostate cancer is cancer that is completely contained within the prostate gland. Doctors look at different factors to divide these into groups according to whether they are likely to grow quickly or slowly or whether they are likely to spread. You can read about the low risk, intermediate risk and high risk groups on our page about risk factors in localised prostate cancer.

 

Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has broken through the outer covering (capsule) of the prostate gland.

 

Metastatic prostate cancer

Metastatic prostate cancer is cancer that has spread to other parts of the body. Prostate cancer most commonly spreads to lymph nodes in other parts of the body or bones. It can spread to other organs though. 

It is sometimes possible to have metastases (cancer spread) present even when the prostate tumour is still very small. So even if the tumour appears to be very small, when a bone scan shows that there is cancer in the bones, the prostate cancer is M1 stage. It will be treated as metastatic cancer and can often be controlled for several years with treatment.

 

More information about staging

If you would like to talk to someone about the stages of prostate cancer, you can contact our cancer information nurses. They would be happy to help. You can also contact one of the prostate cancer organisations

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Updated: 17 February 2014