Whether you have just been diagnosed or a family member of someone that is currently fighting prostate cancer, you may have found yourself at some point asking what are the stages of prostate cancer? The more you understand prostate cancer stages, the better equipped you will be to understand the treatment options and screening methods.
AJCC TNM staging
The American Joint Committee on Cancer TNM staging system describes how far the cancer has spread. It’s made up of:
- The primary Tumor
- The status of the lymph Nodes
- Whether the cancer has Metastasized
- The PSA level at diagnosis
- The Gleason score
The clinical stage is based on your doctor’s estimate from the DRE, lab tests, biopsy, and imaging. If you’ve had surgery, the doctor can determine the pathologic stage.
- T1: No tumor can be seen or felt
- T1a: Cancer is found during a TURP and is less than 5% of the tissue
- T1b: Cancer is found during a TURP and is more than 5% of the tissue
- T1c: Cancer is found by needle biopsy
- T2: The tumor can be seen and/or felt, but is confined to the prostate
- T2a: The cancer is in one half or less of one side of your prostate
- T2b: The cancer is more than one half of only one side of your prostate
- T2c: The cancer is in both sides of your prostate
- T3: The cancer has grown outside of your prostate
- T3a: The cancer is outside the prostate, but not in the seminal vesicles
- T3b: The cancer is in the seminal vesicles
- T4: The cancer has spread to your urethral sphincter, recutm, bladder, and/or pelvis
Lymph node staging
- NX: Lymph nodes have not been tested
- N0: Cancer has not spread to any nearby lymph nodes
- N1: Cancer has spread to one or more nearby lymph nodes
- M0: Cancer has not spread beyond nearby lymph nodes
- M1: Cancer has spread beyond nearby lymph nodes
- M1a: Cancer has spread to lymph nodes outside your pelvis
- M1b: Cancer has spread to your bones
- M1c: Cancer has spread to other organs
Stage I prostate cancers are small and fully contained in the prostate. They have a low PSA level and a Gleason score of 6 or less. They grow slowly and may never cause any symptoms or health problems.
If you are young and healthy, you may opt for watchful waiting, knowing you may need to treat your cancer at some point in the future. Some people want to treat their cancer right away and go forward with radiation therapy or have their prostate removed. Men who are elderly or in ill health often choose to monitor their cancer and may escape having to ever treat it.
Stage II prostate cancers are still contained in the prostate, but are more aggressive. They are larger, have higher Gleason scores, and have higher PSA levels. Stage II cancers are more likely to eventually spread and cause symptoms.
Active surveillance is still an excellent option for Stage II cancers, especially when it’s not causing any symptoms. Men who are elderly or ill often choose to skip treatment, as they are unlikely to suffer any ill effects from the prostate cancer.
Men who are young, healthy, and/or want to treat their cancer may decide to have their prostate removed or treat the cancer with radiation.
Stage III prostate cancer means the cancer has spread outside the prostate, but it hasn’t gone very far. At this point, most people will have their prostate removed, get radiation, or have hormone therapy. While it hasn’t yet spread to lymph nodes, it’s now considered more likely to come back after treatment, even if it’s successful. Some people with stage III prostate cancer will still decide that watchful waiting or less aggressive treatment is the best choice for them.
Stage IV prostate cancer has spread out of the prostate and into other areas. It may be in your bladder or rectum, to nearby lymph nodes, or in other organs. Any place the cancer has spread outside of your pelvis is considered ‘distant.’ Your experience and prognosis will be very different, depending on how far the cancer has spread and where it has metastasized.
While sometimes stage IV prostate cancer can be cured, most of the time you will have cancer the rest of your life. Many men live with incurable prostate cancer for years and can continue enjoying their lives. At this point, most doctors will aim to shrink the tumors and keep the cancer from spreading further. They will also provide you with treatment in order to improve your quality of life — so you can continue spending time with your family, working, and enjoying hobbies — and make sure you aren’t in pain.
Prostate cancer nearly always spreads from the lymph nodes to the bones. Once cancer has spread to the bones, it can cause fractures, breaks, and intense pain. If you have extreme pain in your lower back or hips, you should go to the ER immediately. Doctors can help stabilize your bone structure and manage your pain.
Bone metastasis, while serious, it is not likely to kill you. People can live for years after cancer has metastasized in their bones. High blood calcium levels can be dangerous.
There are specific treatments for prostate cancer once it’s reached your bones.
Bisphosphonates slow down bone cells called osteoclasts. Osteoclasts can become overactive when you have prostate cancer, so bisphosphonates can help relieve pain and high calcium levels, slow the growth of cancer, and help strengthen bones if you’re getting hormone therapy. The most common bisphosphonate is zoledronic acid, or Zometa. You’ll get this through an IV about once a month, along with supplements for calcium and vitamin D.
Bisphosphonates can leave you feeling like you have the flu. They may aggravate any joint or bone pain you’re already having. They can also cause kidney problems, so make sure your whole treatment team knows about any kidney problems you might have.
The most serious side effect from bisphosphonates is osteonecrosis of the jaw (ONJ). This is rare, but can lead to tooth loss and jaw infections, so you should have a dental checkup before you start treatment. You should not have any dental work done during treatment and you should carefully floss, brush, and get regular dental checkups. You can learn more about ONJ from the team at Savor Health.
Denosumab, also known as Xgeva or Prolia, also blocks osteoclasts. It can help prevent fractures and slow the spread of cancer. It’s frequently used for men when bisphosphonates and hormone therapy aren’t working as well as they should. It’s typically injected once a month, along with calcium and vitamin D supplements. Denosumab can cause nausea, diarrhea, and leave you feeling exhausted. It also puts you at risk for ONJ.
Radiopharmaceuticals kill cancer cells in your bones. They’re administered through an IV and settle into damaged areas of your bones, so they reach cancer in your bones throughout your body. The most common radiopharmaceuticals are strontium-89 (Metastron), samarium-153 (Quadramet), and radium-223 (Xofigo). These drugs decrease your blood cell count, which puts you at risk for infections and you have to be very careful about bleeding. Different drugs can cause different side effects, so ask your treatment team what to expect.
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