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The staging, grading and prognosis of prostate cancer

Staging

The tests completed help your doctors work out if you have prostate cancer and whether it has spread. This is called staging. It helps you and your health care team decide which management or
treatment option is best for you.

The most common staging system for prostate cancer is the TNM system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.

Your doctor may also describe the cancer as:

  • localised (early) – the cancer is contained inside the prostate
  • locally advanced – the cancer is larger and has spread outside the prostate to nearby tissues or nearby organs such as the bladder, rectum or pelvic wall
  • advanced (metastatic) – the cancer has spread to distant parts of the body such as the lymph nodes or bone. This is called prostate cancer even if the tumour is in a different part of the body.
T stands for tumourRefers to the size of the tumour (T0–4). The higher the number, the larger the cancer.
N stands for nodesN0 means the cancer has not spread to lymph nodes, while N1 means it has spread to lymph nodes in the pelvis.
M stands for metastasisM0 means the cancer has not spread outside of the pelvis, while M1 means it has spread to lymph nodes, bone or other organs outside the pelvis.

Grading prostate cancer

The biopsy results will show the grade of the cancer. Grading describes how the cancer cells look under a microscope compared to normal cells.

For many years, the Gleason scoring system has been used to grade the tissue taken during a biopsy. If you have prostate cancer, you will have a Gleason score between 6 (slightly abnormal) and 10 (more abnormal).

A newer system has been introduced to simplify the grading and make it easier to understand. Known as the International Society of Urological Pathologists (ISUP) Grade Group system, this grades prostate cancer from 1 (least aggressive) to 5 (most aggressive).

Risk of progression

Based on the size and grade of the tumour, and your PSA level before the biopsy, localised prostate cancer will be classified as:

  • low risk – the cancer is slow growing and not aggressive
  • intermediate risk – the cancer is likely to grow faster and be mildly to moderately aggressive
  • high risk – the cancer is likely to grow quickly and be more aggressive.

This is known as the risk of progression. The risk category helps guide management and treatment.

Working out the stage, grade and risk category of prostate cancer is complex, so ask your doctor to explain  how it applies to you. You can also call Cancer Council 13 11 20 for information and support.

Risk level - lowGleason score = 6 or less; ISUP grade group = 1
Risk level - intermediateGleason score = 7; ISUP grade group = 2-3
Risk level - highGleason score = 8-10; ISUP grade group = 4-5

Your doctor will also look at your PSA level and the tumour (T) size to help work out the cancer’s risk level.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.

To work out your prognosis, your doctor will consider test results, the type of prostate cancer, the stage, grade and risk category, how well you respond to treatment, and factors such as your age, fitness and medical history.

Prostate cancer often grows slowly, and even the more aggressive cases of prostate cancer tend to grow more slowly than other types of cancer. Some low-risk prostate cancers grow so slowly that they never cause any symptoms or spread, others don’t grow at all.

Compared with other cancers, prostate cancer has one of the highest five-year survival rates if diagnosed early.

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This information is reviewed by

This information was last reviewed in March 2022 by the following expert content reviewers: A/Prof Ian Vela, Urologic Oncologist, Princess Alexandra Hospital, Queensland University of Technology, and Urocology, QLD; A/Prof Arun Azad, Medical Oncologist, Urological Cancers, Peter MacCallum Cancer Centre, VIC; A/Prof Nicholas Brook, Consultant Urological Surgeon, Royal Adelaide Hospital and A/Prof Surgery, The University of Adelaide, SA; Peter Greaves, Consumer; Graham Henry, Consumer; Clin Prof Nat Lenzo, Nuclear Physician and Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics, and Notre Dame University Australia, WA; Henry McGregor, Men’s Health Physiotherapist, Adelaide Men’s Health Physio, SA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, NSW; Dr Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW; A/Prof David Smith, Senior Research Fellow, Daffodil Centre, Cancer Council NSW; Allison Turner, Prostate Cancer Specialist Nurse (PCFA), Canberra Region Cancer Centre, Canberra Hospital, ACT; Maria Veale, 13 11 20 Consultant, Cancer Council QLD; Michael Walkden, Consumer; Prof Scott Williams, Radiation Oncology Lead, Urology Tumour Stream, Peter MacCallum Cancer Centre, and Professor of Oncology, Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC.