The Different Stages of Prostate Cancer
For solid cancerous tumors such as prostate cancer, doctors use staging as a way to describe where the cancer is located, if it has spread outside the prostate, and whether it affects other parts of your body. Staging also helps doctors plan the most appropriate treatment based on those factors and your age, health, life expectancy and personal treatment preferences.
Here’s an overview of each prostate cancer stage; all include a general survival rate prognosis using the widely quoted 5-year survival rate that compares what percentage of men with the same type and stage of prostate cancer are still alive 5 years after they were diagnosed.
Stage I
What does it mean? Stage I cancer is limited to the prostate, and often found during another medical procedure. Usually slow growing, it cannot be felt during a digital rectal exam (DRE) and is not visible through imaging tests.
How is it typically treated?
- For younger, healthier men, watchful waiting (closely monitoring to see if the tumor grows or changes), radiation therapy or radical prostatectomy (surgical removal of the prostate along with surrounding tissues and lymph nodes)
- Watchful waiting for elderly men who have not experienced prostate cancer symptoms or who have other serious health problems that may potentially shorten their lifespan
- Radiation therapy (external beam radiation or brachytherapy) or radical prostatectomy for older men who wish to start treatment
What is the long-term prognosis? An estimated 4 out of 5 prostate cancers are discovered at stage I or stage II; the relative 5-year survival rate for localized prostate cancer is 100%.
Stage II
What does it mean? Stage II tumors are still either too small to be felt or seen, or have become slightly larger and can be felt during a DRE. These cells are more abnormal than at stage I and grow more quickly, but have not spread beyond the prostate gland. Cancers at this stage are more likely to spread beyond the prostate without treatment
How is it typically treated?
- Watchful waiting for men whose stage II cancer has not caused any symptoms and for older men without symptoms but who have other health problems. Radiation therapy and radical prostatectomy are also options.
- Radical prostatectomy, followed by external beam radiation if doctors find the cancer spread beyond the prostate or if post-surgery testing still detects prostate specific antigen (PSA) levels for younger, otherwise healthy men.
- Other treatment options include external beam radiation, brachytherapy only or a combination of the two. Doctors may combine radiation therapy with hormone therapy, and may be able to offer or suggest participation in clinical trials.
What is the long-term prognosis? An estimated 4 out of 5 prostate cancers are discovered at stage I or stage II; the relative 5-year survival rate for localized prostate cancer is 100%.
Stage III
What does it mean? Stage III cancer has spread beyond the outer layer of the prostate but has not yet reached the bladder or rectum, and has not yet spread to lymph nodes or other parts of the body.
How is it typically treated?
- External beam radiation plus hormone therapy; external beam radiation and brachytherapy with additional hormone therapy; and radical prostatectomy, possibly followed by radiation therapy.
- Older men, especially those with other medical problems, may also opt for watchful waiting or a less aggressive approach such as hormone therapy.
- Clinical trials may also be an option.
What is the long-term prognosis? The relative 5-year survival rate for regional stage III prostate cancer is nearly 100%.
Stage IV
What does it mean? This stage encompasses any prostate cancer that has spread to the bladder, rectum or nearby lymph nodes, or to the bones, liver or lungs. While most stage IV cancers can’t be cured, doctors can treat them using options that may keep the cancer under control while maintaining or improving one’s quality of life.
How is it typically treated?
- Hormone therapy (in combination with chemotherapy)
- External beam radiation (sometimes with brachytherapy), along with hormone therapy
- Radical prostatectomy in instances where the cancer has not spread to the lymph nodes or other areas of the body
- Transurethral resection of the prostate (TURP) surgery to relieve bleeding or urinary obstruction
- Treatment that helps prevent pain or is aimed at cancer that has metastasized to the bones
What is the long-term prognosis? The relative 5-year survival rate for distant stage prostate cancer is 28%.
Doctors diagnose more than 180,000 new cases of prostate cancer every year. Remember that survival rates in this overview are just estimates, and that new treatment options may be available in the time since these rates were measured. Prostate cancer is one cancer that can be treated successfully, especially if you stay up to date with recommended screenings that improve your chance of receiving an early-stage diagnosis. If you are ever told you have prostate cancer, it’s important to find a doctor to work closely with in reaching consensus on what treatment regimen is right for you based on your age and stage of life.
