Understanding Prostate Cancer Stages: From 1 to 4 and Treatment Options

Prostate cancer is a type of cancer that begins in the prostate gland, which is approximately the size of a walnut and is part of the male reproductive system. The prostate produces seminal fluid and helps provide nutrients for sperm. Prostate cancer develops when cells in the prostate become abnormal and begin multiplying uncontrollably.

Once prostate cancer has been diagnosed, doctors determine its stage to understand the size of the cancer and how far it has progressed. Prostate cancer is generally classified from stage 1 to stage 4, with each stage having different characteristics and levels of spread. Determining the stage is important because it helps doctors assess the cancer and select the most appropriate treatment for each patient.

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Prostate Cancer Stages and Their Meaning

Here are the stages of prostate cancer from stage 1 to stage 4 and what they mean:

Stage 1

Stage 1 prostate cancer means the cancer is small and remains within the prostate gland. The cancer generally affects less than half of one side of the prostate. At this stage, the PSA level is low and the Grade Group is 1.

Treatment for stage 1 prostate cancer generally involves active surveillance because the cancer is small and tends to grow slowly. However, some patients, particularly younger patients, may choose to undergo treatment after considering the potential benefits and side effects in pursuit of cancer cure.

Stage 2

Stage 2 prostate cancer remains confined to the prostate gland but may involve a larger portion of the prostate than stage 1. This stage includes cancers with low to intermediate PSA levels and Grade Groups ranging from 1 to 4.

Stage 2A. Stage 2A prostate cancer has a Grade Group of 1. The cancer may be small and affect only one side of the prostate with an intermediate PSA level. It may also be larger and involve both sides of the prostate while having a low PSA level.
Stage 2B. Stage 2B prostate cancer has a Grade Group of 2 and a low or intermediate PSA level. The cancer can be any size as long as it has not grown beyond the prostate.
Stage 2C. Stage 2C prostate cancer has a Grade Group of 3 or 4 and a low or intermediate PSA level. The cancer can be any size as long as it remains confined to the prostate.

Treatment for stage 2 prostate cancer may include active surveillance, particularly when PSA levels and the Grade Group are low. If treatment is chosen, options may include surgery to remove the prostate, known as prostatectomy, and radiation therapy. Radiation treatment may include radiotherapy (external beam radiation therapy) or brachytherapy.

Stage 3

Stage 3 prostate cancer is more advanced than stage 2. At this stage, the cancer may have grown through the prostate tissue. Stage 3 also includes cancers with higher PSA levels and higher Grade Groups.

Stage 3A. Stage 3A prostate cancer is characterized by a high PSA level. This stage may include Grade Groups 1 through 4. The cancer can vary in size as long as it has not grown beyond the prostate.
Stage 3B. In stage 3B, the cancer has grown beyond the prostate and may extend to the seminal vesicles, bladder, rectum, or other nearby organs. PSA levels and Grade Groups can vary at this stage.
Stage 3C. Stage 3C prostate cancer has a Grade Group of 5. The cancer can be any size and the PSA level can be at any level. The cancer may have grown beyond the prostate but has not spread to the lymph nodes or other parts of the body.

Treatment for stage 3 prostate cancer is generally necessary unless the patient has another health condition requiring more urgent treatment. Stage 3 cancer has a higher risk of spreading because the cancer has grown beyond the prostate or shows characteristics of faster growth. Treatment options may include surgery or a combination of radiation therapy and hormone therapy.

Stage 4

Stage 4 prostate cancer means the cancer has spread beyond the prostate gland. This is also known as metastatic prostate cancer. Stage 4 cancer can occur with any PSA level and any Grade Group.

Stage 4A. Stage 4A prostate cancer has spread to nearby lymph nodes.
Stage 4B. Stage 4B prostate cancer has spread to other parts of the body, such as the bones, liver, or lungs.

Treatment for stage 4 prostate cancer generally begins with hormone therapy. If the cancer has spread to nearby lymph nodes, surgery and radiation therapy to the prostate may still be options in certain cases. If the cancer has spread to other parts of the body, treatment generally involves medicines that work throughout the body to control or destroy prostate cancer cells.

How Do Doctors Determine the Stage of Prostate Cancer?

To determine the stage of prostate cancer, doctors assess several factors that indicate how extensive the cancer is within the prostate, whether it has spread, and how aggressively the cancer cells are growing. This information is then used to determine the cancer stage and help develop an appropriate treatment plan.

Several factors doctors consider when staging prostate cancer include:

How Extensive the Cancer Is Within the Prostate

If the cancer affects only a small portion of the prostate gland, the cancer is generally at a lower stage. Conversely, the more extensive the area of the prostate affected by cancer, the higher the stage may be.

Whether the Cancer Has Spread Beyond the Prostate

Doctors assess whether cancer cells have grown through the prostate wall and spread into surrounding tissues, such as the rectum, bladder, or other nearby areas. Spread to tissues outside the prostate may indicate a more advanced stage.

Whether the Cancer Has Spread to the Lymph Nodes

Prostate cancer can spread through the lymphatic system to nearby lymph nodes. If cancer cells have reached the lymph nodes, this may indicate more advanced disease.

Whether the Cancer Has Spread to Other Organs

In advanced stages, prostate cancer can metastasize or spread to other parts of the body. The bones are one of the most common sites of spread, but cancer may also spread to organs such as the liver and lungs.

PSA Level in the Blood

Prostate-specific antigen (PSA) is a protein produced by prostate cells. PSA levels in the blood can be one of the factors considered when determining the cancer stage. In general, a PSA level below 10 ng/mL is considered low, 10–20 ng/mL is intermediate, and above 20 ng/mL is considered high.

Grade Group Based on the Gleason Score

Doctors also consider the Grade Group, which is determined based on the Gleason Score. The Grade Group ranges from 1 to 5. Lower numbers generally indicate cancer cells that are more likely to grow slowly, while higher numbers indicate more aggressive cancer that may grow more quickly.

What Do the Numbers and Letters in Prostate Cancer Staging Mean?

Prostate cancer stages use numbers from 1 to 4 to describe how far the cancer has progressed and how aggressive its characteristics are. In general, a lower stage indicates that the cancer remains confined to the prostate and has characteristics associated with slower growth.

Some stages are further divided using letters, such as stage 2A, 2B, and 2C. These subdivisions help doctors classify the cancer in greater detail based on factors such as tumor size, spread, PSA level, and cancer cell characteristics.

By understanding the prostate cancer stage comprehensively, doctors can determine the treatment option that is most appropriate for each patient’s condition and cancer characteristics.

Prostate Cancer Treatment Options at Mandaya Royal Hospital Puri

Prostate cancer treatment at Mandaya Royal Hospital Puri is tailored to the cancer stage, cancer characteristics, overall health, and individual needs of each patient. Treatment options may include surgery, systemic therapy, radiotherapy, and nuclear medicine therapy for advanced or metastatic prostate cancer.

Among the available treatment options, two therapies highlighted in prostate cancer care at Mandaya Royal Hospital Puri are Lutetium-177 PSMA therapy and robotic prostatectomy using the da Vinci Xi surgical system.

1. Lutetium-177 PSMA Therapy

In advanced or metastatic prostate cancer, cancer cells have spread from the prostate to other parts of the body, most commonly the bones. One treatment option that may be considered in certain cases is Lutetium-177 PSMA therapy.

Lutetium-177 PSMA is a nuclear medicine therapy that uses a specific radioactive medication administered through an injection into the bloodstream. Once inside the body, the medication seeks out prostate cancer cells that express PSMA (Prostate-Specific Membrane Antigen).

The medication then attaches to the cancer cells and delivers radiation directly to the target. The radiation emitted by Lutetium-177 helps damage and destroy cancer cells, with the aim of delivering a more targeted dose of radiation to cancerous tissue.

The number of treatment sessions can vary from patient to patient. Under certain treatment regimens, patients may receive several sessions with several months between treatments. The doctor will determine the number and interval of treatments based on the cancer’s condition, response to therapy, and the patient’s overall health.

2. Robotic Prostatectomy with the da Vinci Xi

For patients with prostate cancer who may still benefit from surgical treatment, one of the options available at Mandaya Royal Hospital Puri is robotic prostatectomy using the da Vinci Xi surgical system.

The procedure uses a robotic-assisted surgical system to help doctors remove the prostate in a controlled and precise manner. The da Vinci Xi system allows the surgeon to control surgical instruments from a console, while a high-definition camera provides a detailed view of the surgical area.

The robotic approach also allows the procedure to be performed through several small incisions rather than the larger incision required for traditional open surgery. Throughout the procedure, the surgeon remains in complete control of the operation, while the robotic system translates the surgeon’s hand movements into more controlled instrument movements.

Robotic prostatectomy is not suitable for every patient. The doctor will first evaluate the cancer stage, tumor location and characteristics, the patient’s condition, and the potential benefits and risks before determining whether this procedure is appropriate.

In addition to Lutetium-177 therapy and robotic prostatectomy, Mandaya Royal Hospital Puri also provides systemic therapy and radiotherapy for prostate cancer when indicated.

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