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  • Staging, grading and prognosis of prostate cancer

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    Your doctor will assign a staging and grading category to your cancer which will help you and your health care team decide which treatment or management option is best for you.

    Staging 

    Staging determines the extent of the cancer and whether it has spread from the original site to other parts of the body. The cancer may be described as one of the following:

    • localised – the cancer is contained within the prostate
    • locally advanced – the cancer is larger and has spread outside the prostate to nearby tissues or organs near the prostate such as the bladder, rectum or pelvic wall
    • metastatic – the cancer has spread to distant parts of the body such as the lymph glands or bones, or secondary tumours have developed away from the primary tumour. This is called prostate cancer even if the tumour is in a different sort of tissue.

    Grading

    Grading describes how aggressive the cancer cells are. This is determined by a pathologist who looks at the cells under a microscope.

    Low-grade cancer cells tend to grow slowly while high-grade cancer cells look abnormal and grow more quickly.

    For many years the Gleason scoring system has been used for grading the tissue taken during a biopsy. All men with prostate cancer will have a Gleason score between 6 and 10. Your doctor will also consider how much cancer there is (its volume). For example, if you have one small area of cancer, your doctor would consider this a low-volume cancer. If you have a low-volume cancer that is also low grade, you might choose to have less aggressive management or treatment such as active surveillance.

    From 2016, a new system will be gradually introduced. Called the International Society of Urological Pathology or ISUP score, this system grades cancer from 1 (least aggressive) to 5 (most aggressive).

    Prognosis

    Prognosis means the expected outcome of a disease. Generally prognosis is better when prostate cancer is diagnosed at an early stage and at a lower grade.

    You will need to discuss your prognosis with your doctor. However it is not possible for any doctor to predict the exact course of the cancer. Test results, the extent of the spread of the cancer and factors such as your age, level of fitness, medical and family history are important in assessing your prognosis. These factors will also help your doctor advise you on the best management or treatment options and tell you what to expect.

    Prostate cancer often grows slowly and even the more aggressive prostate cancers tend to grow more slowly than other types of cancer. Compared with other cancers, prostate cancer has one of the highest five-year survival rates. For many men the prostate cancer grows so slowly that it never needs treatment. Many men live with prostate cancer for many years without any symptoms and without it spreading.

    Assessing risk of cancer progression
    For men diagnosed with localised prostate cancer, risk of progression may be categorised as low, intermediate or high. The risk is determined by combining biopsy grading, clinical staging and pre-biopsy PSA along with overall health, age and wishes, to determine the most appropriate course of management or treatment. 

    This website page was last reviewed and updated April 2017.

    Information last reviewed April 2016 by: A/Prof Nicholas Brook, Consultant Urological Surgeon, Royal Adelaide Hospital and Clinical Associate Professor in Surgery, University of Adelaide, SA; Prof Ian Davis, Professor of Medicine and Head of Eastern Health Clinical School, Monash University and Senior Oncologist, Eastern Health, VIC; A/Prof David Smith, Senior Research Fellow and Cancer Epidemiologist, Cancer Council NSW, NSW; A/Prof Peter Reaburn, Associate Professor in Exercise and Sport Sciences, CQU, QLD; Sylvia Burns, Senior Cancer Specialist, Cancer Council Queensland, QLD; Robyn Tucker, Clinical Nurse Specialist, Cancer Information and Support, Cancer Council Victoria, VIC.

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