Prostate Cancer Clinical Staging

When prostate cancer is diagnosed, it is assigned a "stage" based on the doctor's evaluation of whether it is localized, whether it has spread within the prostate, or whether it has spread outside the gland.

The "stage" of prostate cancer -- describing the extent of the cancer or the degree to which it has spread -- is one of the most important considerations in selecting the treatment, and one of the most significant in terms of the prognosis.

The most widely used staging system is the TNM (tumor, node, metastases) system, adopted by the American Joint Committee on Cancer and the International Union Against Cancer in 1992. TNM staging has now largely replaced the older Jewett-Whitmore system, which classifes cancer as stages A-B-C-D.

The TNM system describes the extent of the primary tumor (T stage), the absence or presence of spread to nearby lymph nodes (N stage), and the absence or presence of distant metastasis (M stage).

T Stages
Stage Substage Definition
T1 Your doctor can't feel the tumor or see it with imaging such as transrectal ultrasound (TRUS).
T1a The cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement, and is present in less than 5 percent of the tissue removed.
T1b The cancer is found after TURP, but is present in more than 5 percent of the tissue removed.
T1c The cancer is found by needle biopsy done because you had an elevated PSA, but no other sign of prostate cancer.
T2 Your doctor can feel the cancer when a digital rectal exam (DRE) is done.
T2a The doctor can feel that the cancer does not involve more than half of one lobe of your prostate.
T2b The doctor can feel that the cancer involves more than half of one lobe of the prostate, but is confined to one side.
T2c The doctor can feel that the cancer involves both sides of the prostate.
T3 The cancer has begun to spread outside your prostate and may involve the seminal vesicles.
T3a The cancer extends outside the prostate on one side only, but has not spread to the seminal vesicles.
T3b The cancer extends outside the prostate on both sides, but has not spread to the seminal vesicles.
T3c The cancer extends outside the prostate, and has spread to one or both of the seminal vesicles.
T4 The cancer has spread to tissues next to your prostate (other than the seminal vesicles), such as your bladder's external sphincter (muscles that help control urination), your rectum, and/or the wall of your pelvis.
T4a The cancer has spread to your bladder's external sphincter (muscles that help control urination) or rectum.
T4b The cancer has spread to the wall of your pelvis.

 

N Stages
Stage Substage Definition

N+

 Spread of cancer to the regional lymph nodes.
  Nx The presence or absence of cancer in your pelvic lymph nodes cannot be assessed.
N0 There is no sign that your cancer has spread to any of the pelvic lymph nodes.
N1 Cancer is found in a single lymph node but it is not more than 2 cm in size.
N2 Cancer is found in a single lymph node that is more than 2 cm but less than 5 cm, or cancer is found in multiple lymph nodes but none greater than 5 cm.
N3 Cancer is found in one or more lymph nodes that is greater than 5 cm.

 

M Stages
Stage Substage Definition

M+

 Metastasis (spread of cancer) through your body.
  Mx There presence or absence of cancer beyond your pelvic lymph nodes cannot be assessed.
M0 There is no sign that your cancer has spread beyond the pelvic lymph nodes.
M1a Cancer is found in lymph nodes beyond the pelvic area.
M1b Cancer is found in the bone.
M1c Cancer is found in other organs.
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