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Stages of Prostate Cancer

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A staging system is a standardized system of indicating the extent to which a cancer has spread. Staging describes the extent or severity of an individual's cancer based on the size of the original (primary) tumor and the extent to which it has spread within the body. While there are several different staging systems for prostate cancer, the most widely used system in the United States is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer (AJCC).

General Information on Staging

Staging is based on knowledge of the manner in which cancer develops. Cancer cells divide and grow to form a mass of tissue called a tumor. As tumor growth progresses, it can invade nearby organs and tissues. Cancer cells may also break away from the tumor, entering the bloodstream or lymphatic system. By moving through the bloodstream or lymphatic system, cancer can spread from the primary site to form new tumors in other organs. The spread of cancer is called metastasis.

Purpose of Staging

Staging aids the cancer diagnosis and treatment process in significant ways:

  • Staging helps doctors in effectively planning a patient's treatment.
  • The stage can be used to estimate a patient's prognosis (likely outcome or course of the disease).
  • Knowing the stage aids in identifying clinical trials (research studies) that may be suitable for a particular patient.

Staging helps researchers and health care providers exchange information about patients, providing a common language for diagnosis, treatment and clinical trials.

Tests to Determine Prostate Cancer Stage

The following tests and procedures may be used in the staging process for prostate cancer:1



Radionuclide bone scan

A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

MRI (magnetic resonance imaging)

A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Pelvic lymphadenectomy

A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.

CT scan (CAT scan)

A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Seminal vesicle biopsy

The removal of fluid from the seminal vesicles (glands that produce semen) using a needle. A pathologist views the fluid under a microscope to find out if cancer is present.

The results of these tests are viewed together with the results of the original tumor biopsy to determine the prostate cancer stage.

Staging Prostate Cancer Using the TNM System

The TNM System describes the extent of the primary tumor (T stage), whether the cancer has spread to nearby lymph nodes (N stage), and the absence or presence of distant metastasis (M stage). The TNM System has been accepted by the International Union Against Cancer (IUAC) and the American Joint Committee on Cancer (AJCC).

The stages described below are based on the most recent version of the AJCC staging manual. The clinical stage is based on your tests before surgery, such as your PSA results and your doctor's assessment of the cancer from the DRE. If you have surgery, your doctors can determine the pathologic stage, based on the surgery and examination of the removed tissue. There are 4 categories for describing the prostate tumor's (T) stage, ranging from T1 to T4.




Your doctor can't feel the tumor or see it with imaging such as transrectal ultrasound.


The cancer is found incidentally during a transurethral resection (often abbreviated as TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed.


The cancer is found after TURP but is present in more than 5% of the tissue removed.


The cancer is found by needle biopsy that was done because of an elevated PSA.


Your doctor can feel the cancer when a digital rectal exam (DRE) is done, but it still appears to be confined to the prostate gland.


The cancer is in one half or less of only one side (left or right) of your prostate.


The cancer is in more than half of only one side (left or right) of your prostate.


The cancer is in both sides of your prostate.


The cancer has begun to spread outside your prostate and may involve the seminal vesicles.


The cancer extends outside the prostate but not to the seminal vesicles.T3b: The cancer has spread to the seminal vesicles.


The cancer has spread to tissues next to your prostate (other than the seminal vesicles), such as your bladder's sphincter (muscles that help control urination), your rectum, and/or the wall of your pelvis.

da Vinci Treatment Options for Prostate Cancer

PN 1002337 Rev A 04/2013

  1. Stages of Prostate Cancer. National Institutes of Health. Available from: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2

Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary.

Risks specific to minimally invasive surgery, including da Vinci ® Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.

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