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How is prostate cancer staged?

If cancer is found in the prostate, your physicians need to know the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The doctor may use various blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings. The results of staging tests help the doctor decide which stage best describes a patient's disease. Clinical and pathological stage of the disease is one of the most important prognostic factors for patient's survival.

Two systems are in common use for the staging of prostate cancer. The "Jewett system" (stages A through D) was described in 1975 and has since been modified. In 1997, the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer adopted a revised TNM system which employs the same broad T stage categories as the Jewett system but includes subcategories of T stage, including a stage to describe patients diagnosed through PSA screening. This revised TNM system is clinically useful and more precisely stratifies newly diagnosed patients. A simplified summary of both staging systems is shown below and both are used in the text of this summary discussing treatment options.


Stage I (A) --The cancer cannot be detected by rectal exam and causes no symptoms. The cancer is usually found during surgery to relieve problems with urination or during a screening PSA blood test. State I tumors may be in more than one area of the prostate, but there is no evidence of spread outside the prostate. 
Stage II (B) --The tumor is felt in a rectal exam or detected by a blood test, but there is no evidence that the cancer has spread outside the prostate. 
Stage III (C) --The cancer has spread outside the prostate to nearby tissues. 
Stage IV (D) --Cancer cells have spread to lymph nodes or to other parts of the body.

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