Staging and grading of prostate cancer This information is an extract from the booklets Understanding early (localised) prostate cancer and Understanding locally advanced prostate cancer. You may find the full booklets helpful. We can send you a free copy – see page 5.
Contents • Staging • Grading • Prostate cancer risk groups for early prostate cancer
Staging The stage of a cancer is a term used to describe its size and whether it has spread. A commonly used staging system is the TNM staging system.
TNM staging The TNM system gives information about the tumour, the lymph nodes and whether the cancer has spread (metastasised). T stands for tumour Doctors put a number next to the T to describe the size and spread of the cancer. T1 – The tumour is within the prostate gland. It is too small to be detected during a rectal examination, but may be picked up through tests such as a PSA test, a biopsy or a transurethral resection of the prostate gland (TURP). This is an operation to make passing urine easier by removing part of the prostate gland. There are generally no symptoms with T1 tumours. T2 – The tumour is still within the prostate gland but is large enough to be felt during a digital rectal examination, or it shows up on a scan. Often there are no symptoms.
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Staging and grading of prostate cancer
The T2 stage is divided into: • T2a – The tumour is only in one half of one of the two lobes that make up the prostate gland. • T2b – The tumour is in more than one half of one of the lobes in the prostate gland. • T2c – The tumour is in both lobes of the prostate gland. T1 and T2 tumours are known as early (localised) prostate cancer. T3 – The cancer has begun to spread through the capsule that surrounds the prostate gland. The T3 stage is divided into: • T3a – The tumour has broken through the capsule but is not affecting the surrounding structures. • T3b – The tumour has spread into the glands that produce semen (seminal vesicles). These are very close to the prostate gland and sit just underneath the bladder. T4 – The tumour has started to spread into nearby parts of the body such as the bladder or rectum.
Bladder T3 tumour
Prostate gland T2 tumour T1 tumour
T (tumour) stages of prostate cancer
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Staging and grading of prostate cancer
T3 and T4 tumours are known as locally advanced prostate cancer because the cancer has started to spread outside the prostate gland and may be invading surrounding structures. If the cancer has spread to other parts of the body, it’s known as metastatic, secondary, or advanced prostate cancer. N stands for nodes This describes whether there are any lymph nodes near the prostate gland that have cancer in them. The N may have an X or a number written next to it, which gives information about the nodes that were examined: • NX – The lymph nodes were not examined. • N0 – The lymph nodes were examined but no cancer was found. • N1 – Cancer was found in the lymph nodes. If you have early prostate cancer, you will most likely see NX or N0 because the cancer is just in the prostate. M stands for Metastasis Metastasis means that the cancer has spread to other parts of the body, such as the bones. The M may have a number written next to it, which gives information about where the cancer has spread to: • M0 – The cancer has not spread to other parts of the body. • M1 – The cancer has spread to another part of the body, such as the bones, lung or liver. If you have early prostate cancer, you will most likely see M0 because the cancer is just in the prostate. You can talk to your doctors about your TNM staging. They will be able to explain it to you. Our cancer support specialists can also tell you more about TNM staging. You can call them on 0808 808 00 00.
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Staging and grading of prostate cancer
Grading The grade of a cancer gives an idea of how quickly it might grow. Prostate cancer is graded according to how the cancer cells look when the biopsy sample is looked at under the microscope. The Gleason system is the most commonly used grading system. It looks at the pattern of cancer cells within the prostate. There are five patterns, which are graded from 1–5. 1 is very similar to normal prostate tissue, whereas 5 is very different to normal tissue. Only grades 3–5 are cancer. All your biopsy samples are graded. The most common grade in the samples and the highest grade of the other samples are added together. This gives a Gleason score that ranges between 6–10. Low-grade cancers have a Gleason score of 6. They are usually slow-growing and less likely to spread. High-grade cancers have a Gleason score of 8–10. They are more likely to grow quickly and to spread.
Prostate cancer risk groups for early prostate cancer Early (localised) prostate cancer is divided into risk groups. These help doctors decide on the best treatment options. There are three risk groups: • Low risk means the prostate cancer is unlikely to grow for many years. • Intermediate risk means the prostate cancer is unlikely to grow for a few years. • High risk means the prostate cancer is more likely to grow or spread in a few years. To work out your risk group for early (localised) prostate cancer, your doctor will look at your Gleason score, your PSA level and the stage of your cancer. If you would like more information about your risk group, ask your doctor.
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Staging and grading of prostate cancer
More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don’t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding early (localised) prostate cancer, Understanding locally advanced prostate cancer or any other cancer information, visit be.macmillan.org.uk or call 0808 808 00 00. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. © Macmillan Cancer Support 2013. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ
REVISED IN FEBRUARY 2015 Planned review in 2017
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