Prostate Cancer Diagnosis and Staging
July 1, 2024
This page was reviewed under our medical and editorial policy by Wesley Yip, M.D., assistant professor, Division of Urology and Urologic Oncology, Department of Surgery, City of Hope® Cancer Center Duarte
If prostate cancer is suspected, the care team may perform a series of tests to ensure an accurate, comprehensive prostate cancer diagnosis and stage. The care team will then use that information to develop a personalized treatment plan.
Screening for Prostate Cancer
Who Should Be Screened for Prostate Cancer?
The current recommendations are that men discuss routine prostate cancer screening options with their primary doctor. The discussion should take place at:
- Age 50 for men of average risk who have an expected lifespan of at least another 10 years
- Age 45 for men at high risk, including African American men and those with a first-degree relative (father or brother) who was diagnosed with prostate cancer before the age of 65
- Age 40 for men at highest risk, including those with two or more first-degree relatives who had prostate cancer at an early age
Depending on the patient's risk level, the care team may recommend two of the most common first-line screening methods: a prostate-specific antigen (PSA) test or a digital rectal examination (DRE). Depending on the results of these screenings and other risk factors, the screening may be repeated annually or once every two years.
Tests for Prostate Cancer
- Physical exam: The caregiver will examine the patient to evaluate his genitourinary system and overall health.
- Prostate-specific antigen (PSA) test: This test measures PSA levels in the patient's blood. Levels that are higher than normal may indicate prostate cancer, but may also suggest noncancerous issues such as an enlarged or inflamed prostate.
- Digital rectal exam (DRE): A doctor inserts a lubricated, gloved finger into the rectum to feel for prostate abnormalities.
- Prostate biopsy: The care team surgically removes suspicious tissue, which is then examined carefully for signs of cancer.
- Transrectal ultrasound: A small probe is inserted into the rectum to take images of the prostate using high-energy sound waves. A biopsy may be taken if the images show any abnormalities. This procedure typically takes less than 10 minutes and the area may be numbed to reduce discomfort.
The results of these tests may help the care team evaluate the cancer grade, which describes how abnormal the cells are. It may also allow them to calculate the Gleason score, which indicates the likelihood of the prostate cancer growing or spreading.
Tests for Prostate Cancer Progression
If prostate cancer is found, additional tests are performed to determine the type and stage of the disease. These diagnostic tests may include those listed below.
- Lymph node biopsy: The removal and examination of lymph nodes in the pelvic region to determine whether cancer has spread.
- Seminal vesicle biopsy: Removal of fluid from the glands that produce semen to check if the cancer has spread.
- Computed tomography (CT or CAT) scan: A series of X-ray images taken at different angles to form a computer-generated image. This can be used to determine tumor size, location and number.
- Bone scan: A procedure using a small amount of radioactive material to determine if prostate cancer has spread to the bones.
- Genomic testing: Cancerous tissue is tested to see if it exhibits certain genetic mutations, which can be used to determine better treatments.
Prostate Cancer Stages
Following diagnosis, the care team will assign a prostate cancer stage based on such details as the patient’s PSA level at the time of diagnosis, the Gleason score, whether cancer was found in other body sites during testing and other factors.
Below are the stages that the care team may discuss with the patient.
Stage 1 Prostate Cancer
At this stage, the cancer is confined to one side of the prostate and is slow-growing. It has not reached the lymph nodes or other parts of the body. Typically, the Gleason score is 6 or lower, and the PSA is 10 or below.
Stage 2 Prostate Cancer
In stage 2, the prostate cancer may have spread to both sides of the prostate gland, but no further. The prostate cancer may also be assigned a substage, as follows:
- Stage 2A: The PSA is between 10 and 19, and the Gleason score is 6 or below.
- Stage 2B: The PSA is below 20, and the Gleason score is 7.
- Stage 2C: The PSA is below 20, and the Gleason score is between 7 and 8.
Stage 3 Prostate Cancer
In stage 3, the cancer may have spread to both sides of the prostate or to nearby tissues, but not to the lymph nodes or other areas of the body. At this point, the care team may assign a substage, as follows:
- Stage 3A: The PSA is 20 or higher, and the Gleason score may go up to 8.
- Stage 3B: Includes any PSA score, with a Gleason score of 8 or below, if the T stage is 3 or 4.
- Stage 3C: Includes any PSA score, with a Gleason score of 9 or 10, if the T stage is 3 or 4.
Stage 4 Prostate Cancer
At stage 4, also called metastatic prostate cancer, the cancer has spread beyond the prostate. A substage is typically assigned using the criteria listed below instead of using the Gleason or PSA score.
- Stage 4A: The cancer has spread to local (nearby) lymph nodes, and possibly to local tissues.
- Stage 4B: The cancer has spread to other locations, such as the bones, other organs or distant lymph nodes.
