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Prostate Cancer Staging

Staging of prostate cancer means determining how advanced is the cancer or how far the cancer has grown.  The more advanced the cancer, the higher the stage.  The following is a simplified table of prostate cancer staging:

Stage I:
Cancer that cannot be felt during a rectal exam.  It is usually discovered by biopsy or when surgery is done for a benign prostatic process.  The cancer is confined to the prostate and occupies a small amount of the prostate.

Stage II:
The cancer is more advanced, but still confined to the prostate.

Stage III:
The cancer is beyond the outer covering or capsule of the prostate, possibly in the seminal vesicles.

Stage IV:
The caner has spread (metastasized) to other organs:

  • Invading into bladder, rectum and/or pelvic wall
  • Spread to lymph nodes
  • Spread to other distant body parts such as bones, liver, brain

TNM Staging
A more detailed form of staging is TNM prostate cancer staging.  The TNM staging system describes the extent of the primary tumor (T), the absence or presence of metastasis to nearby lymph nodes (N) and the absence or presence of distant metastasis (M).

Stage Description
T1 Not palpable by DRE, confined to prostate
T1a Incidentally found on TURP Less than 5% tissue
T1b Incidentally found on TURP more than 5% of tissue
T1c Found by needle biopsy due to elevated PSA
T2 Confined to prostate on DRE or prostatectomy
T2a Tumor involves half of one lobe or less
T2b Tumor involves more than half of one lobe
T2c Tumor involves both lobes
T3 Tumor through prostate capsule
T3a Tumor just beyond capsule on one side
T3b Tumor just beyond capsule on both sides
T3c Tumor invades seminal vesicle(s)
T4 Tumor extends to adjacent organs
T4a Tumor invades bladder/external sphincter/rectum
T4b Tumor invades levator muscles/pelvic side wall
Node (N) Regional (pelvic) lymph nodes
N0 No lymph node (LN) metastasis
N1 Tumor in one LN less than 2 cm
N2 Tumor in one LN between 2-5 cm
N3 Metastasis one or more LN more than 5 cm
Metastasis (M) Tumor spread to distant sites
M0 No distant metastasis
M1a Distant (non-regional) LN involvement
M1b Metastasis to the bones
M1c Metastasis to other distant organs (lung, Brain)

Relationship between TNM Prostate Cancer Staging and Stage
Categories I to IV:

Stage T N M
I T1 N0 M0
II T2 N0 M0
III T3 N0 M0
IV T4 N0 — N3 M0 — M1
Any T N0 — N3 M1
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