Staging in Depth

Staging in Depth

Three key factors are used to determine the cancer stage: T (the size of the tumor), N (if the lymph nodes are involved in the cancer) and M (if the cancer has metastasized, or spread, to other organs in the body).

T Categories

TX       

Primary tumor cannot be assessed

T0

No evidence of a primary tumor

T1

Tumor is present but not felt during DRE or seen with imaging technology

 

T1a

Tumor accidentally during transurethral resection of the prostate (TURP) to treat BPH. Cancer present in less than five percent of tissue removed.

 

T1b

Cancer found during TURP but present in more than five percent of tissue removed.

 

T1c

Cancer found during needle biopsy performed because of elevated PSA. In T1c the physical exam of the prostate is normal.

T2

Tumor is felt during DRE but has not spread outside the prostate.

T2a

Cancer in half or less than half of only one side of the prostate.

T2b

Cancer in more than half of only one side of the prostate.

T2c

Cancer is in both sides of the prostate.

T3

Cancer has grown outside of the prostate or may be in seminal vesicles.

T3a

Cancer has spread to tissue immediately outside of the prostate but not in seminal vesicles.

T3b

Cancer is in the seminal vesicles.

T4

Cancer has spread to other areas near the prostate (other than seminal vesicles), including the bladder, rectum or pelvic wall.


N Categories

N0

Cancer has not spread to any lymph nodes.

N1

Cancer has spread to one or more nearby (regional) lymph nodes located in the pelvis.


M Categories

M0

Cancer has not spread (metastasized) beyond the regional lymph nodes.

M1

Cancer has spread beyond the regional lymph nodes.

M1a

Cancer has spread to distant lymph nodes located outside of the pelvis.

M1b

Cancer has spread to the bones.

M1c

Cancer has spread to other organs, such as the lungs. This is with or without cancer spreading to the bones.


Overall Staging

After the T, N and M categories are assigned, the information is combined with the Gleason score. The combined information is used to assign an overall stage (I - IV) based on the severity of the cancer. The lower the stage, the less aggressive the cancer.

Stage

TNM                   

PSA

Gleason     

Stage I
what it means

T1a -c, N0, M0
T2a, N0, M0
T1 - T2a

<10
<10
PSA X

6 or lower
6 or lower
Gleason X

Stage IIA
what it means

T1a-c, N0, M0
T1a-c, N0, M0
T2a, N0, M0
T2b, N0, M0
T2b, N0, M0

<20
10<PSA<20
<20
<20
PSA X

Gleason 7
6 or lower
7 or lower
7 or lower
Gleason X

Stage IIB
what it means

T2c, N0, M0
T1-2, N0, M0
T1-2, N0, M0

Any PSA
<= 20
Any PSA

Any Gleason
Any Gleason
8 or higher

Stage III
what it means

T3a-c, N0, M0

Any PSA

Any Gleason

Stage IV
what it means

T4, N0, M0
Any T, N1, M0
Any T, Any N, M1

Any PSA
Any PSA
Any PSA

Any Gleason
Any Gleason
Any Gleason
Any Gleason

Stage I: The cancer is small, very slow growing and found only in the prostate. The tumor cannot be felt during a digital rectal exam (DRE) and does not show up with any imaging technology.

Stage IIA: The tumor has grown within the prostate but has not spread outside of the prostate.

Stage IIB: The tumor has grown within the prostate but has not spread outside of the prostate.

Stege III: Cancer has spread beyond the capsule of the prostate into the area immediately beyond the capsule.

Stage IV: Cancer has metastasized, or spread, beyond the prostate to other areas like the bladder, rectum, lymph nodes and bones. This stage of prostate cancer is not usually considered curable.

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