The stage of prostate cancer is a key factor in determining the most appropriate treatment. While symptoms may provide clues, staging identifies the cancer’s location and whether it has spread within or beyond the prostate.
The good news is that many forms of prostate cancer are highly treatable and often progress slowly compared to other cancers. Even advanced stages have several effective options to manage the disease.
In this guide, we explore the four stages of prostate cancer, the symptoms that may be associated with each stage, and the treatment options most commonly considered.
How Prostate Cancer Is Staged
Prostate cancer is classified into four stages, from Stage I to Stage IV. Each stage reflects the extent of cancer progression, from localised disease to advanced cancer that has spread beyond the prostate.
Current clinical standards for prostate cancer staging are defined by the AJCC Cancer Staging Manual. The AJCC uses the TNM staging system alongside PSA levels and Gleason score (Grade Group) to assign an overall prostate cancer stage.
The TNM Staging System
Prostate cancer staging starts with the TNM system, which uses imaging, biopsy results, and clinical assessment to evaluate:
- whether the primary tumour (T) is confined to the prostate or has grown beyond it
- whether nearby lymph nodes (N) are involved
- whether the cancer has spread to distant organs (M), known as metastatic disease
Tumour stage (T) ranges from T0 to T4, with some stages divided into subcategories (a, b, or c) to specify growth. Lymph node (N) and metastasis (M) stages are recorded as 0 or 1 to indicate the presence or absence of spread.
The table below shows what each TNM classification means.
| Category | Description |
| T0 | No evidence of a primary tumour |
| T1 | Tumour cannot be felt during a digital rectal exam (DRE) or seen on imaging; often found incidentally |
| T1a | Cancer found in 5% or less of removed tissue |
| T1b | Cancer found in more than 5% of removed tissue |
| T1c | Tumour identified by needle biopsy |
| T2 | Tumour can be felt on DRE or seen on imaging. Cancer is confined to the prostate |
| T2a | Tumour involves half or less of one side of the prostate |
| T2b | Tumour involves more than half of one side |
| T2c | Tumour involves both sides of the prostate |
| T3 | Tumour has grown beyond the prostate capsule |
| T3a | Tumour extends outside the prostate but not into the seminal vesicles |
| T3b | Tumour has spread into the seminal vesicles |
| T4 | Tumour has spread into nearby structures such as the bladder, rectum, or pelvic wall |
| N0 | Cancer has not spread to nearby lymph nodes |
| N1 | Cancer has spread to nearby lymph nodes |
| M0 | Cancer has not spread to distant parts of the body |
| M1 | Cancer has spread to distant parts of the body |
PSA Levels and Grade Groups
In addition to TNM classification, physicians also consider PSA levels and Grade Group to determine the overall stage of prostate cancer.
PSA (prostate-specific antigen) is a protein produced by prostate tissue. PSA levels measured at diagnosis can help estimate tumour burden and disease activity, though PSA alone does not determine stage.
Grade Groups, based on the Gleason score, indicate how aggressive the cancer appears under the microscope and its likelihood of growth and spread.
The Gleason score is calculated by adding the two most common gland patterns seen in a biopsy. This score is then grouped into Grade Groups 1 through 5:
- Grade Group 1 (Gleason ≤6): low-grade cancer
- Grade Group 2–3 (Gleason 7): intermediate-grade cancer
- Grade Group 4–5 (Gleason 8–10): high-grade cancer
Together, TNM classification, PSA level, and Grade Group are used to assign a prostate cancer stage. The following sections describe each stage in detail.
Stage I Prostate Cancer
Stage I prostate cancer is localised and typically considered low risk. The cancer is confined to the prostate and has not spread to lymph nodes or distant sites.
Stage I is usually associated with T1 or T2a disease, no lymph node involvement or metastases (N0, M0), a Gleason score of 6 or lower (Grade Group 1), and PSA levels below 10 ng/mL.
This stage is usually slow-growing and often asymptomatic, allowing patients time to consider management options before deciding on intervention.
Common Symptoms of Stage I Prostate Cancer
Most men with Stage I prostate cancer have no symptoms. The disease is often detected through PSA screening, and the tumour is usually not palpable on examination.
If symptoms are present, they are usually mild and may resemble those of benign prostatic hyperplasia (BPH), such as:
- Increased urinary frequency
- Difficulty starting or maintaining urine flow
- Weak urine stream
- Mild discomfort during urination
- Occasional pelvic discomfort
Best Treatment Options for Stage I
Stage I prostate cancer is typically low risk and slow to progress. Many physicians recommend active surveillance, which involves monitoring rather than immediate treatment, to avoid potential side effects of prostate cancer surgery or radiation.
For patients who prefer active treatment, focal therapies may be considered. Common approaches include cryotherapy and high-intensity focused ultrasound (HIFU). As thermal treatments, these options carry risks related to heat-induced damage to surrounding structures.
At Vitus Private Clinic, we focus on non-thermal focal therapies such as irreversible electroporation (IRE) and photodynamic therapy (PDT) for selected Stage I cases. These methods target cancer locally while minimising damage to surrounding structures and preserving function.
Stage II Prostate Cancer
Stage II prostate cancer remains localised to the prostate without spread to lymph nodes or distant sites. Compared to Stage I, it has higher risk features such as increased PSA, tumour extent, or Grade Group.
Stage II is divided into three subcategories:
Stage IIa
Cancer is confined to the prostate and is low grade (Grade Group 1), usually associated with T1 or limited T2 disease and no lymph node involvement or metastases (N0, M0). This stage is defined by higher PSA levels (10–20) or limited tumour involvement, but the cancer has not spread beyond the prostate.
Stage IIb
Cancer is confined to the prostate and is intermediate grade (Grade Group 2), most often associated with T1 or T2 disease with N0 and M0 status. The tumour may or may not be detectable on examination or imaging, and PSA levels are typically below 20. The higher Grade Group reflects increased aggressiveness compared to Stage IIa.
Stage IIc
Cancer remains localised to the prostate but is higher grade (Grade Group 3 or 4), associated with T1 or T2 disease, N0, and M0. PSA levels are typically below 20, but the cancer appears more aggressive, increasing the risk of progression compared to other Stage II subtypes.
Common Symptoms of Stage II Prostate Cancer
Stage II prostate cancer is still localised, and many men may not have obvious symptoms. However, urinary symptoms are more likely than in Stage I due to greater tumour involvement.
When symptoms occur, they are usually related to changes in urinary function and may include:
- Increased urinary frequency
- Difficulty starting or maintaining urine flow
- Weak urine stream
- Mild discomfort during urination
- A sensation of incomplete bladder emptying
- Occasional pelvic discomfort
Best Treatment Options for Stage II
Stage II prostate cancer is generally low to intermediate risk. Some patients may be suitable for active surveillance, while others with more aggressive tumours may need active treatment.
Prostatectomy is often suggested for localised prostate cancer, but it carries risks such as erectile dysfunction and urinary incontinence due to potential damage to surrounding tissue.
At this stage, focal therapies can still be highly effective, especially electroporation-based treatments like irreversible electroporation and prostate electrochemotherapy, which aim to treat cancer while preserving surrounding structures.
Stage III (Locally Advanced) Prostate Cancer
Stage III prostate cancer is locally advanced, with possible growth beyond the prostate capsule and involvement of nearby structures, but no spread to lymph nodes or distant organs. Local treatment, often combined with other therapies, can still be effective.
Stage III is divided into three subcategories based on tumour extent, PSA level, and Grade Group.
Stage IIIa
The cancer is confined to the prostate (T1 or T2, N0, M0), with Gleason scores of 8 or lower (Grade Group 1–4) and PSA levels of 20 or higher. The tumour may be detectable during a digital rectal exam or on imaging.
Stage IIIb
The cancer has spread outside the prostate but not to nearby lymph nodes (T3 or T4, N0, M0). Grade Group remains 1–4, and PSA levels can be any value.
Stage IIIc
The cancer may be growing into tissues near the prostate but has not spread to lymph nodes or distant organs (any T, N0, M0). This stage is defined by a Gleason score of 9 or 10 (Grade Group 5), and PSA levels can be any value.
Common Symptoms of Stage III Prostate Cancer
For many patients, Stage III is when symptoms first become noticeable, especially urinary symptoms from tumour growth beyond the prostate capsule.
Possible symptoms of Stage III prostate cancer may include:
- Weak or reduced urine stream
- Increased urinary frequency
- Nocturia (waking at night to urinate)
- Difficulty initiating urination or feeling unable to empty the bladder
- Urinary incontinence
- Blood in the urine or semen
- Pelvic or perineal discomfort
- Erectile dysfunction
As the cancer extends beyond the prostate, symptoms are more likely to result from pressure on surrounding structures rather than distant spread.
Best Treatment Options for Stage III
Because Stage III prostate cancer varies, individualised planning is essential to tailor treatment to each case.
Most cases are treated with a combination of radiation and hormone therapy to slow progression and destroy cancer cells. External beam radiation (such as CyberKnife) and brachytherapy are common, but both carry potential side effects from radiation exposure.
At Vitus Private Clinic, selected patients with locally advanced prostate cancer can be treated with electroporation-based focal therapies, including electrochemotherapy (ECT) or a combined approach using irreversible electroporation with electrochemotherapy (IRECT).
ECT treats larger tumours or those near critical structures, while IRECT combines immediate tumour ablation with enhanced chemotherapy to address more complex cases and preserve nearby structures.
Stage IV (Advanced or Metastatic) Prostate Cancer
Stage IV prostate cancer is advanced or metastatic, with cancer spread beyond the prostate to distant lymph nodes, bones, or other organs. Treatment at this stage typically focuses on systemic therapy rather than localised approaches.
Stage IV prostate cancer is divided into two subcategories based on the pattern of spread.
Stage IVa
In Stage IVa prostate cancer, the cancer may be growing into tissues near the prostate and has spread to nearby lymph nodes, but not to distant organs (any T, N1, M0). PSA levels and Grade Group can vary.
Stage IVb
In Stage IVb, the cancer has spread to distant sites, most commonly bones, distant lymph nodes, or other organs (any T, any N, M1). PSA levels and Grade Group can be any value. This stage represents fully metastatic disease.
Common Symptoms of Stage IV Prostate Cancer
As prostate cancer spreads to distant lymph nodes, bones, or organs, symptoms are more likely to reflect systemic disease rather than local urinary changes.
Possible symptoms of Stage IV prostate cancer may include:
- Persistent fatigue
- Unintentional weight loss
- Bone pain, often in the back, hips, pelvis, or ribs, which may worsen over time
- Nausea or vomiting in some cases
- Changes in urinary function, including increased frequency or discomfort
Not all patients with metastatic prostate cancer experience symptoms at the same time or severity. Symptom patterns vary based on cancer location and activity.
Best Treatment Options for Stage IV
At Stage IV, treatment shifts from curative intent to controlling disease progression, managing symptoms, and maintaining quality of life. Hormone therapy is commonly recommended to block hormones that drive cancer growth and slow progression.
Over time, prostate cancer can develop resistance to hormone therapy and progress to castration-resistant disease. When this occurs, additional options such as chemotherapy, targeted therapies, or radiopharmaceuticals may be introduced.
These treatments help control the disease but are not curative and may have cumulative side effects.
Immunotherapy for Metastatic Prostate Cancer
At Vitus Private Clinic, selected patients with advanced or metastatic prostate cancer can be treated using a combination of non-thermal focal therapies and immunotherapy, depending on the extent and pattern of metastatic disease.
This strategy is based on the understanding that the immune system is uniquely capable of identifying and targeting cancer cells throughout the body, including microscopic disease that cannot be detected on imaging.
Prostate cancer, however, is inherently a cold tumour, meaning it typically does not trigger a strong immune response. While immunotherapy can help activate the immune system, it is most effective when tumour antigens are preserved and made visible to immune cells.
Tumour antigens are found within prostate cancer cells. Many conventional treatments, including radiation therapy, prostatectomy, and thermal focal therapies, can reduce the availability of tumour antigens during treatment. In contrast, electroporation-based, non-thermal focal therapies are designed to destroy cancer cells while preserving tumour antigens.
For this reason, Vitus combines non-thermal focal treatments with immunotherapy to support immune recognition of prostate cancer cells at the primary site and potentially beyond. This approach aims to enhance whole-body immune engagement in selected metastatic cases.
Considering Your Options?
Every prostate cancer diagnosis is unique, so it is important to carefully consider all available treatment options. While radiotherapy and prostatectomy are standard, they carry significant side effects and are not the only approaches available.
At Vitus Private Clinic, we specialise in minimally invasive prostate cancer treatments that target cancer locally while supporting the body’s immune response. This approach aims to improve cancer control, reduce side effects, and preserve quality of life.
Contact Vitus Private Clinic to request a consultation or learn more about personalised prostate cancer treatment options.
Call us now on +49 (0)177 23 82 863 or get in touch using the contact form
Frequently Asked Questions
Yes. Prostate cancer stage can change as new imaging tests, prostate biopsy results, or clinical findings become available, or if the disease progresses. Staging reflects the most accurate information at a given time, which is why ongoing monitoring and follow-up testing are important throughout care.
No. Symptoms do not always correspond to stage. Many men with early-stage prostate cancer have no symptoms at all, while some men with advanced disease may feel relatively well. Staging is based on tumour spread and biological features, not symptom severity.
Stage describes where the cancer is located and whether it has spread. Risk category reflects how aggressive the cancer appears and how likely it is to grow or spread. Treatment decisions are typically based on both factors together, rather than stage alone.
Yes. Although Stage II prostate cancer is still confined to the prostate gland at diagnosis and considered localised prostate cancer, some cases have features that increase the risk of progression over time. PSA test results, Grade Group, tumour extent, and response to monitoring all help determine whether treatment or continued surveillance is appropriate.
In many cases, yes. Stage III prostate cancer is considered locally advanced, but treatment may still aim to control or eradicate the disease depending on tumour characteristics and patient factors. Management often involves a combination of local and systemic therapies tailored to the individual case.
American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 8th Edition. Springer; 2017.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Current version.