Prostate cancer treatment explained by stage

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A doctor may recommend a biopsy if they believe prostate cancer may be present. During a biopsy, a healthcare professional removes a small tissue sample from the prostate and sends it to a lab for testing.

Once a doctor confirms a diagnosis of prostate cancer, they can determine the stage. A healthcare professional can use the stage to help create a treatment plan. The treatments become more comprehensive if the cancer has spread and is at a higher stage.

The Gleason score ranks prostate cancer on a scale of 1 to 10. A score of 6 suggests low grade cancer, while 7 represents a medium grade. A score of 8 to 10 is considered high grade cancer.

PSA levels

Prostate-specific antigen (PSA) is a protein that the prostate gland makes. A healthcare professional uses a PSA blood test to screen people for prostate cancer. A PSA level of below 4 nanograms per milliliter (ng/mL) of blood is a normal range. If a person’s PSA level is over 10 ng/mL, the chance of having prostate cancer is over 50%.

Gleason score vs. grade groups

The American Joint Committee on Cancer (AJCC) TNM staging system is a comprehensive system for grading prostate cancer.

This staging system considers:

• the size of the tumor
• whether the cancer has spread
• any node involvement
• PSA levels
• the Gleason score

There are four major stages to this system.

Stage 1 is the earliest stage of prostate cancer. It carries a lower risk to the person. During this phase, the cancer has not spread, and the tumor is still small.

In this stage, the PSA level is typically less than 10 ng/mL, and the Gleason score is 6 or less.

With stage 1 prostate cancer, the doctor may not be able to feel the tumor during a rectal exam. Typically, it is found by biopsy or PSA test.

Treatment

A healthcare professional may recommend the following treatments for stage 1 prostate cancer:

• active surveillance, which involves monitoring the cancer and initiating treatment if it worsens
• radiation therapy
• radical prostatectomy, which is the removal of the prostate and some surrounding tissue

The majority of people with prostate cancer at this stage live for 5 or more years following diagnosis.

In stage 2 prostate cancer, the tumor is larger and can typically be felt during a rectal exam or seen on imaging. The cancer may have spread through the prostate gland but has not spread to the lymph nodes or other areas.

In this stage, the PSA level is between 10 and 20 ng/mL, and the Gleason score is between 6 and 8.

Treatment

Treatment for stage 2 prostate cancer typically involves the same options as stage 1. This includes active surveillance, radiation therapy, or radical prostatectomy.

As with stage 1 prostate cancer, the majority of people with stage 2 survive 5 or more years following diagnosis.

Stage 3 prostate cancer means the cancer may have grown out of the prostate and spread to the surrounding tissues. However, it has not spread to the lymph nodes or other areas of the body.

The PSA level depends on how much the tumor has spread outside the prostate gland, but it may be 20 ng/mL or more. At this stage, the Gleason score is 6 to as high as 10.

Treatment

A doctor may treat stage 3 prostate cancer more aggressively than stage 1 or stage 2.

Standard treatment for this stage includes:

• radiation therapy
• hormone therapy
• active surveillance
• radical prostatectomy

To help control the cancer and lessen any urinary symptoms a person experiences, a doctor may recommend:

• transurethral resection of the prostate (TURP), a procedure that involves using a tube with a cutting tool to remove tissue through the urethra
• a clinical trial of cryosurgery
• internal radiation with radioactive seeds

Around 95% of people with stage 3 prostate cancer survive 5 or more years following diagnosis.

Stage 4 prostate cancer means the tumor has spread to the lymph nodes. It may or may not have spread to other areas of the body, including the bladder, back, or rectum.

The PSA level can be any value, and the Gleason score can be any number.

Treatment

Stage 4 prostate cancer treatment focuses on slowing the progression of the cancer and may be more aggressive than at other stages.

A doctor may recommend:

• depletion of the testosterone hormone via medical castration or surgical castration
• chemotherapy
• radiation therapy
• bisphosphonate therapy or medications that treat high calcium levels and bone pain that are the result of some cancers

Around 50% of people with stage 4 prostate cancer survive 5 or more years following diagnosis.

The following are some questions people frequently ask about prostate cancer stages.

What is stage 4 prostate cancer life expectancy?

If prostate cancer has spread to distant parts of the body, the 5-year relative survival rate is around 32%.

What percent of prostate cancers are aggressive?

In around 15% of prostate cancer diagnoses, the cancer has spread to other sites and is in the more aggressive stage 4.

Prostate cancer is typically a slow-growing, non-aggressive form of cancer. A healthcare professional uses the Gleason score, PSA level, tumor size, and location of the cancer to determine the stage. They can then use the staging information to help create a treatment plan.

They may use a combination of radiation, hormone therapy, chemotherapy, and surgery to manage the progression of the cancer and the symptoms that may accompany it. In the early stages of the disease, healthcare professionals may choose to monitor its progression and only treat it if the tumor grows.