What Are the Stages of Prostate Cancer?

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

Stages and grades of prostate cancer relate to how aggressively the cancer spreads in your body. The higher the number, the more aggressive the cancer. These stages and grades are important to determining the type of treatment you will receive.

Prostate cancer typically grows slowly and is readily treatable in the first two stages. But if you receive no treatment, some forms of the cancer can spread rapidly to other parts of your body.

As defined by the National Cancer Institute (NCI), the stages of prostate cancer include the following:

• Stage I  - tumor cells are found in less than 5 percent of prostate tissue removed, and the cells are not very aggressive in nature
• Stage II - tumor cells are found in less than 5 percent of prostate tissue removed, and the cells are more aggressive in nature or the tumor is larger in size, but is confined to the prostate gland
• Stage III - tumor has grown through the capsule that surrounds the prostate gland, and may involve seminal vesicles (tubes that carry sperm)
• Stage IV - tumor has spread to other structures beyond the seminal vesicles to any other organ or structure
• Recurrent - cancer has come back (recurred) after treatment; cancer may recur in the prostate or in another part of the body

Grade of Prostate Cancer 

Another step in the diagnostic process is grading the cancer cells, which means assessing how fast the tumor is likely to grow and spread. Grading is done in the laboratory with cells taken from a prostate gland biopsy. The cancer cells are measured by how closely they look like normal cells. 

This grading system—called a Gleason score—assigns a grade score ranging from 2 to 10. In general, the lower the number, the lower the grade, and the slower the cancer is growing. A higher score indicates a higher grade of the tumor. High-grade tumors grow more quickly than low-grade tumors and are more likely to spread to other parts of the body. 

• A score of 4 or lower means that the cancer cells look similar to normal cells, and the cancer is likely to be less aggressive. 
• Grades 5 to 7 are considered intermediate. This means that the cancer cells do not look like normal cells and are more likely to be aggressive and grow faster than those with a grade under 4. 
• Grades 8 to 10 indicate that the cancer cells are more likely to be very aggressive in growth.