What are prostate cancer symptoms and staging?
Many men who get prostate cancer have no symptoms. That’s why prostate cancer screenings are key to catching the disease early. As prostate cancer grows, the tumor can put pressure on the gland or cause the gland to get bigger (enlarged prostate). At this point, you may experience symptoms.
What are the symptoms of prostate cancer?
Problems using the bathroom are often an indication of a prostate problem, including prostate cancer. You may feel the need to pee more often, especially at night. You may notice that your urine stream is weak or that the flow starts and stops. Some men experience pain while peeing.
Other symptoms include:
blood in semen or urine
difficulty getting an erection (erectile dysfunction)
hip, back, or chest pain
loss of bowel control (fecal incontinence)
pain during ejaculation
weakness or numbness in the legs or feet
From the community: “I never had any of the trademark symptoms of prostate cancer. No urological problems at all and only slightly higher than normal PSA. Major problem for me before diagnosis was pain in one hip when walking and increasing weakness in my thighs. Took a while to check out other possible causes until Dr. finally ordered MRI scan which showed a tumor on the prostate and advanced illness confirmed later by the usual tests and skyrocketing PSA. Point of all this is that I clearly remember for a month or so, well before diagnosis, my urine developed a strange smell. Sort of a cross between a chemical and high voltage ozone. This was before any treatment or medication. Has me wondering if many of you guys out there remember noticing the same thing.” – Inspire member
How is prostate cancer staged?
Cancer stage indicates whether prostate cancer has spread outside the original tumor to other parts of the body. Prostate cancer that spreads is known as metastatic prostate cancer.
Staging takes place at the time of diagnosis. This information helps your doctor develop the most effective treatment plan. A cancer stage can change any time after your original diagnosis if cancer spreads.
Doctors use a combination of the American Joint Committee on Cancer’s tumor, node, metastasis (TNM) system, protein-specific antigen (PSA) levels, and Grade Group to determine the stage of prostate cancer. The system considers these five factors:
Tumor growth: Your doctor determines if cancer is only in the prostate gland. This is known as localized or T2 tumors. Cancers that spread into organs in the pelvic area, such as the bladder or rectum, are distant or T4 tumors.
Lymph node involvement: Your doctor checks for the presence of cancer cells in nearby lymph nodes or in the pelvic area.
Metastasis: Your doctor assesses if cancer has spread (metastasized) outside of the prostate gland to other parts of the body. Prostate cancer most commonly spreads to the bones and lymph nodes. It sometimes spreads to the liver, lungs, or brain.
PSA level: A PSA reading of 10 nanograms per milliliter (ng/mL) or higher at the time of diagnosis often indicates cancer. A reading below 4 ng/mL probably isn’t cancer. Numbers that fall in between (borderline range) may indicate cancer.
Gleason score Grade Group: Results from a prostate biopsy help your doctor determine the aggressiveness of the cancer (how likely it is to spread).
What is the Gleason score for prostate cancer?
Your Gleason score and Grade Group help your doctor gauge existing cancer spread. This information also helps determine the likelihood of the disease to metastasize to other parts of the body. To get this information, your doctor calculates:
Cancer grade: Using a scale of 1 to 5, a lab pathologist grades about a dozen biopsy samples. A grade of 3 indicates a slow-growing (low-grade) cancer, while a grade of 5 is an aggressive, fast-growing, or high-grade cancer. A biopsy sample that gets a 1 or 2 is considered to be normal (noncancerous) tissue. These samples aren’t a factor in cancer staging.
Gleason score: Your doctor adds the most common cancer grade seen in all of the biopsy samples to the second most common grade. This total is the Gleason score.
What are prostate cancer Grade Groups?
Your Gleason score determines your Grade Group. There are 5 Grade Groups, with 1 being the least serious and 5 being the most serious.
Grade Group 1: A Gleason score of 6 or lower indicates a slow-growing cancer that might not require treatment (low-grade cancer).
Grade Groups 2, 3, and 4: A midrange score of 7 or 8 indicates a moderately aggressive cancer that likely needs to be treated (intermediate-grade cancer).
Grade Group 5: A Gleason score of 9 or higher suggests an aggressive, fast-growing cancer that requires immediate treatment (high-grade cancer).
From the community: “…Out of the 12 cores taken in my prostate biopsy 9 were Gleason 8 and 9 which is high risk cancer. Mine had already spread to my pelvis. Once outside the prostate it is not curable only can be treated. I am also stage 4…” – Inspire member
What if results aren’t conclusive?
If biopsy results are inconclusive, it means the cells don’t look normal, but they don’t look like cancer either. You may have a higher risk of developing prostate cancer in the future. Your doctor will want to monitor your health more closely, and perhaps conduct another biopsy later on.
Several conditions can cause these abnormal (but not cancerous) results.
Atypical small acinar proliferation (ASAP): Also called glandular atypia or atypical glandular proliferation, these results indicate a high likelihood of cancer. However, there aren’t enough abnormal cells to make a diagnosis. Your doctor may recommend repeating the biopsy in a few months.
Prostatic intraepithelial neoplasia (PIN): Prostate cells show changes in their appearance. In low-grade PIN, cells look almost normal. In high-grade PIN, cell patterns look abnormal. High-grade PIN increases your cancer risk.
Proliferative inflammatory atrophy (PIA): Prostate cells appear smaller than usual and show signs of inflammation. PIA may eventually lead to high-grade PIN or prostate cancer.
From the community: “My story is that my PSA test climbed in one year over 0.75 which is the standard of care reason for an ultrasound guided transrectal biopsy (TRUS). Had first a prostate MRI to localize where to do the biopsies and then 13 actual biopsy samples of which 3 came out positive. Had full body CT which did not show anywhere else and then within a month radical prostatectomy with lymph node removal. Today, 2 years later, PSA still undetectable.” – Inspire member
Sources
Key Statistics for Prostate Cancer. American Cancer Society. January 2020.
Observation or Active Surveillance for Prostate Cancer. American Cancer Society. August 2019.
Prostate Cancer Risk Factors. American Cancer Society. June 2020.
Prostate Cancer Stages and Other Ways to Assess Risk. American Cancer Society. August 2019.
Radiation Therapy for Prostate Cancer. American Cancer Society. August 2019.
Screening Tests for Prostate Cancer. American Cancer Society. August 2019.
Survival Rates for Prostate Cancer. American Cancer Society. January 2020.
Tests to Diagnose and Stage Prostate Cancer. American Cancer Society. January 2020.
Treating Prostate Cancer Spread to Bones. American Cancer Society. August 2019.
What’s New in Prostate Cancer Research. American Cancer Society. August 2019.
What Is Prostate Cancer? American Cancer Society. August 2019.
Advanced Prostate Cancer. American Urological Association.
Adenocarcinoma. Cancer Treatment Centers of America.
Metastatic Prostate Cancer. Cancer Treatment Centers of America. November 2020.
Hypercalcemia. Mayo Clinic. March 2020.
Gleason Score and Grade Group. Prostate Cancer Foundation.
Prostate Cancer Metastases. Prostate Cancer Foundation.
Prostate Cancer Staging. Prostate Cancer Foundation.
Disclaimer
Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.
This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.
