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Staging means finding out how far prostate cancer has spread in your body. Physicians group prostate cancers into stages I (1) through IV (4), with stage I being the least advanced and stage IV being the most advanced. When your Fred Hutch Cancer Center team designs your treatment plan, they will take into account the stage of your cancer, along with many other factors. The stage is an important part of choosing which treatments are right for you.
The stage depends on:
- How far the cancer has spread.
- Your prostate-specific antigen (PSA) level at the time of diagnosis.
- Your grade group (how abnormal your cancer cells look under a microscope, which tells your team how likely the cancer is to grow and spread quickly). This is captured in your Gleason score.
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Here’s what each stage means in more detail:
Stage I (1)
Cancer is only in your prostate. Your PSA is below 10, and your grade group is 1.
- Your physician cannot feel the cancer in a digital rectal exam. It was found by a needle biopsy because your PSA was high, or it was found in tissue taken out for some other reason (like benign prostatic hyperplasia).
- Or your physician can feel the cancer in a digital rectal exam, and it is in one-half or less of one side of your prostate.
Stage II (2)
Cancer is only in your prostate, but it’s more advanced than stage I.
- Stage IIA: Cancer is in one-half or less of one side of your prostate; your PSA is at least 10 but lower than 20, and your grade group is 1. Or cancer is in more than one-half of one side of your prostate or in both sides; your PSA is lower than 20, and your grade group is 1.
- Stage IIB: Cancer is in one or both sides of your prostate. Your PSA is lower than 20, and your grade group is 2.
- Stage IIC: Cancer is in one or both sides of your prostate. Your PSA is lower than 20, and your grade group is 3 or 4.
Stage III (3)
- Stage IIIA: Cancer is in one or both sides of your prostate. Your PSA is at least 20, and your grade group is 1, 2, 3 or 4.
- Stage IIIB: Cancer has spread to the seminal vesicles or nearby tissues or organs. Your PSA can be any level, and your grade group is 1, 2, 3 or 4.
- Stage IIIC: Cancer is in one or both sides of your prostate. It may have spread to the seminal vesicles or nearby tissues or organs. Your PSA can be any level, and your grade group is 5.
Stage IV (4)
- Stage IVA: Cancer is in one or both sides of your prostate. It may have spread to the seminal vesicles or nearby tissues or organs. It has spread to nearby lymph nodes. Your PSA can be any level, and your grade group is 1, 2, 3, 4 or 5.
- Stage IVB: Cancer has spread to other parts of your body, such as your bones or distant lymph nodes.
Causes of Prostate Cancer
The exact cause of prostate cancer is unknown. But generally speaking, it happens because of changes (mutations) in cell DNA.
- DNA is the chemical that makes up your genes
- Genes control when your cells grow, divide into new cells and die
- DNA mutations can cause prostate cells to grow abnormally and lead to cancer if:
- They turn on genes that help cells grow and divide (oncogenes)
- They turn off genes that slow cell division or make cells die when they should (tumor-suppressor genes)
Prostate Cancer Survival Rates
In cancer care, “survival rate” usually means the percentage of people expected to survive their cancer for at least five years from the time it was diagnosed. Data experts estimate this rate based on information about large groups of people with the same type of cancer. The rate doesn’t include the risk of dying during that five years for some other reason. For prostate cancer, the relative five-year survival rate overall in the United States is 97.9%, according to the National Cancer Institute.
But the chance of surviving cancer for five years or more can be quite different from person to person. One important reason is the stage of the disease at the time of diagnosis. For prostate cancer that’s only in or near the prostate (localized or regional disease), the relative five-year survival rate is 100%. For prostate cancer that has spread to distant parts of the body (metastatic disease), the rate is about 38%. Even within a subset of people, like those with distant spread, there will be differences. Patients may have different treatments and respond to treatments in different ways.
This means it’s impossible to predict the likely lifespan of any one person based on survival rates. If you would like to know more about the outlook for your disease, talk with your Fred Hutch care team. They can tell you more based on your unique situation.
At Fred Hutch, we will tailor your treatment plan to you. In general, people who have the same stage of prostate cancer often have the same or similar treatments. But the stage of the disease is not the only important factor. Your care team will take other factors into account, too, like the risk that your cancer will spread.
Some patients have a combination of treatments. But not everyone needs all the treatments listed here. Common treatments by stage may include:
- Stage I: Watchful waiting, active surveillance, surgery or radiation therapy (sometimes followed by hormone therapy)
- Stage II: Watchful waiting, active surveillance, surgery, radiation therapy or hormone therapy
- Stage III: Watchful waiting, active surveillance, surgery, radiation therapy or hormone therapy
- Stage IV: Watchful waiting, active surveillance, radiation therapy, hormone therapy, chemotherapy, bisphosphonates (medicines to lower the risk of bone fracture) or molecular therapy (a type of internal radiation therapy) for cancer that has spread to the bones
You might have further options in certain situations, like if your cancer has certain genetic changes or if it has come back. Along with many of the options listed above, you might have immunotherapy with sipuleucel-T or an immune checkpoint inhibitor or get a targeted therapy called a PARP inhibitor.
Learn more about prostate cancer treatment.
Physicians and scientists at Fred Hutch are working to discover and develop new ways to treat metastatic prostate cancer. Newer forms of hormone therapy have helped some men live longer with this form of the disease. Researchers are also studying ways to combine hormone therapies and PARP inhibitors, a type of targeted therapy.
Immune checkpoint inhibitors have shown promise for men whose cancer has certain genetic changes. Work goes on to find more ways to treat late-stage prostate cancer with these or other immunotherapies.
Molecular therapies, also called radiopharmaceuticals (a type of internal radiation therapy), are also used in advanced prostate cancer.
Fred Hutch does clinical trials of new options for late-stage disease so you can get access to promising therapies that aren’t offered everywhere. Your care team can tell you about the more recent developments and any open trials that match your situation.
Learn more about prostate cancer treatment.
Treatment is not likely to rid you of stage IV or metastatic prostate cancer. But there are treatments that can help you live a longer, better life with prostate cancer that’s advanced. These include radiation therapy, hormone therapy, chemotherapy, targeted therapy, immunotherapy, surgery and molecular therapy. Measures like these may slow your cancer and reduce cancer symptoms. Some men might choose watchful waiting or active surveillance. Your Fred Hutch care team can explain all your options and how to get the best results.