Prostate cancer occurs in the prostate, a gland in the male reproductive system. Read more about prostate cancer here. Show
 How is prostate cancer staged?Prostate cancer is staged using TNM method of staging cancer, a system generally used to stage cancers that form tumours. Two additional parameters, the PSA levels and the grade (depending on the Gleason score) are used to state prostate cancer. Stage II of prostate cancer:In this stage, the cancer has spread within the prostate involving one or both the lobes of the prostate. These cancers do not spread beyond the prostate to nearby lymph nodes or other organs. Stage II of prostate cancer is broadly categorized into three further stages: Stage IIA:Here, the cancer has spread upto one complete lobe of the prostate. The Gleason score of these cancer is 6 or less than 6 and PSA levels are between 10 and 20. When the cancer is found during biopsies, and not through general diagnostic tests, it is staged as cT1, N0, M0 Grade Group 1. When the cancer can be found to be confined to one half of a lobe of the prostate, through screening or physical examinations and has not metastasized, it is staged as cT2a or pT2, N0, M0, Grade Group 1. If the cancer is contained in more than half of one lobe of the prostate, but has not spread, it is staged as cT2a or pT2, N0, M0, Grade Group 1. Stage IIB:In this stage, the cancer has not spread beyond the prostate, but is contained in more than one lobe of the prostate, with a Gleason score of 7 and PSA levels up to 20. It is staged as T1 or T2, N0, M0, Grade Group 2. Stage IIC:This stage of stage II cancer is staged as T1 or T2, N0, M0, Grade Group 3 or 4 with a Gleason score of 7 or 8 and PSA levels less than 20. They are spread within the prostate, with the cancer contained in both the lobes. How is stage II prostate cancer treated?In stage II of prostate cancer, the cancer is small and is confined to the prostate gland and the growth and spread may be slow and it may never show symptoms. The course of action depends on the age of the patient and their overall health and if they can withstand the treatment. The following are the treatment methods generally preferred for stage I prostate treatment: Active surveillance:Because this cancer type grows very slowly, men may often not require any treatment immediately if not throughout their lifetime. Active surveillance is a method of monitoring the cancer closely regularly. PSA blood test, DRE (digital rectal examination), prostate biopsies may be done once in six months or so. If the results show signs of the cancer spreading, the treatment options are reviewed to eliminate the cancer. External beam radiation:It is a type of radiation therapy, a treatment method that involves use of high beams of X rays to kill cancerous cells. In external beam radiation therapy, also called EBRT, beams of radiation are focused on the prostate gland from
a machine outside the body and it is used to treat the early stages of cancer. Brachytherapy:Brachytherapy is a type of radiation therapy too. Also called seed implantation or interstitial radiation therapy, small radioactive pellets of the size of a grain of rice are placed directly inside the prostate gland. This treatment is used alone in patients in the early stages of cancer showing relatively slow growth. Otherwise, this is preferred in combination of other treatment methods. Radical prostatectomy:Surgery is the preferred choice of treatment for prostate cancers that show symptoms but is confined to the the prostate gland. The main type of surgery used is called radical prostatectomy, in which in addition to the prostate gland, the tissue around it including the seminal vesicles may be removed. Radical retropubic prostatectomy and radical perineal prostatectomy are the two types of surgeries depending on how the prostate is approached. Read more about surgery for prostate cancer here.
Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.The prostate is a gland in the male reproductive system. It lies just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland makes fluid that is part of the semen. EnlargeProstate cancer is most common in older men. In the U.S., about 1 out of 8 men will be diagnosed with prostate cancer. Signs of prostate cancer include a weak flow of urine or frequent urination.These and other signs and symptoms may be caused by prostate cancer or by other conditions. Check with your doctor if you have any of the following:
Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer. EnlargeTests that examine the prostate and blood are used to diagnose prostate cancer.The following tests and procedures may be used:
A biopsy is done to diagnose prostate cancer and find out the grade of the cancer (Gleason score).A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells. EnlargeSometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia. If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score. To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score. The Gleason score can range from 6 to 10. The higher the Gleason score, the more likely the cancer will grow and spread quickly. A Gleason score of 6 is a low-grade cancer; a score of 7 is a medium-grade cancer; and a score of 8, 9, or 10 is a high-grade cancer. For example, if the most common tissue pattern is grade 3 and the secondary pattern is grade 4, it means that most of the cancer is grade 3 and less of the cancer is grade 4. The grades are added for a Gleason score of 7, and it is a medium-grade cancer. The Gleason score may be written as 3+4=7, Gleason 7/10, or combined Gleason score of 7. Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis and treatment options depend on the following:
Treatment options also may depend on the following:
Most men diagnosed with prostate cancer do not die of it. Stages of Prostate CancerKey Points
After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose prostate cancer are often also used to stage the disease. (See the General Information section.) In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score. The following tests and procedures also may be used in the staging process:
There are three ways that cancer spreads in the body.Cancer can spread through tissue, the lymph system, and the blood:
Cancer may spread from where it began to other parts of the body.When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. Denosumab, a monoclonal antibody, may be used to prevent bone metastases. Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.The Grade Group and PSA level are used to stage prostate cancer.The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly. The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. The following stages are used for prostate cancer:Stage IEnlargeIn stage I, cancer is found in the prostate only. The cancer:
Stage IIIn stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA, IIB, and IIC. In stage IIA, cancer:
In stage IIB, cancer:
In stage IIC, cancer:
Stage IIIStage III is divided into stages IIIA, IIIB, and IIIC. EnlargeIn stage IIIA, cancer:
In stage IIIB, cancer:
In stage IIIC, cancer:
Stage IVStage IV is divided into stages IVA and IVB. EnlargeIn stage IVA, cancer:
In stage IVB, cancer:
Prostate cancer may recur (come back) after it has been treated.The cancer may come back in the prostate or in other parts of the body. Treatment Option OverviewKey Points
There are different types of treatment for patients with prostate cancer.Different types of treatment are available for patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Eight types of standard treatment are used:Watchful waiting or active surveillanceWatchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test. Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life. Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer. Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management. SurgeryPatients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. The following types of surgery are used: In some cases, the nerves that control penile erection can be saved with nerve-sparing surgery. However, this may not be possible in men with large tumors or tumors that are very close to the nerves. Possible problems after prostate cancer surgery include the following:
Radiation therapy and radiopharmaceutical therapyRadiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are different types of radiation therapy:
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy, internal radiation therapy, and radiopharmaceutical therapy are used to treat prostate cancer. Men treated with radiation therapy for prostate cancer have an increased risk of having bladder and/or gastrointestinal cancer. Radiation therapy can cause impotence and urinary problems that may get worse with age. Hormone therapyHormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the amount of male hormones or block them from working. This is called androgen deprivation therapy (ADT). Hormone therapy for prostate cancer may include the following:
Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and itching. See Drugs Approved for Prostate Cancer for more information. ChemotherapyChemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). See Drugs Approved for Prostate Cancer for more information. Targeted therapyTargeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
ImmunotherapyImmunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This cancer treatment is a type of biologic therapy. Sipuleucel-T is a type of immunotherapy used to treat prostate cancer that has metastasized (spread to other parts of the body). See Drugs Approved for Prostate Cancer for more information. Bisphosphonate therapyBisphosphonate drugs, such as clodronate or zoledronate, reduce bone disease when cancer has spread to the bone. Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss. In these men, bisphosphonate drugs lessen the risk of bone fracture (breaks). The use of bisphosphonate drugs to prevent or slow the growth of bone metastases is being studied in clinical trials. There are treatments for bone pain caused by bone metastases or hormone therapy.Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. Treatments for bone pain include the following: See the PDQ summary on Pain for more information. New types of treatment are being tested in clinical trials.This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. CryosurgeryCryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy. Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum. High-intensity–focused ultrasound therapyHigh-intensity–focused ultrasound therapy is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves. Proton beam radiation therapyProton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (tiny particles with a positive charge) to kill tumor cells. This type of treatment can lower the amount of radiation damage to healthy tissue near a tumor. Photodynamic therapyA cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs. Treatment for prostate cancer may cause side effects.For information about side effects caused by treatment for cancer, see our Side Effects page. Patients may want to think about taking part in a clinical trial.For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment.Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website. Follow-up tests may be needed.Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups. Treatment of Stage I Prostate CancerTreatment of Stage II Prostate CancerTreatment of Stage III Prostate CancerTreatment of Stage IV Prostate CancerTreatment of Recurrent or Hormone-Resistant Prostate CancerTo Learn More About Prostate CancerFor more information from the National Cancer Institute about prostate cancer, see the following: For general cancer information and other resources from the National Cancer Institute, see the following: About This PDQ SummaryPhysician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions
have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish. PDQ is a service of the NCI. The NCI is part of the National Institutes
of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH. This PDQ cancer information summary has current information about the treatment of prostate cancer. It is meant to inform and help patients, families, and
caregivers. It does not give formal guidelines or recommendations for making decisions about health care. Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new
information. The date on each summary ("Updated") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about
the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Clinical trials can be found online at
NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237). PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].” The best way to cite this PDQ summary is: PDQ® Adult Treatment Editorial Board. PDQ Prostate Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at:
https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389353] Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ
summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images. The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page. More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us. How long can a person live with Stage 2 prostate cancer?Stage 2. Stage 2 means the cancer is in more than half of one side of the prostate. But it is still completely contained within the prostate gland. Almost everyone (almost 100%) will survive their cancer for 5 years or more after they are diagnosed.
Is Stage 2 prostate cancer considered advanced?Cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA, IIB, and IIC. In stage IIA, cancer (1) is found in one-half or less of one side of the prostate.
What is the most successful prostate cancer treatment?Radiation Therapy
This type of treatment uses high doses of radiation energy to treat cancer. Radiation therapy is a good choice for many men with early-stage prostate cancer. It is also the best treatment for older men or those who have other health problems.
Does Stage 2 prostate cancer require chemo?Stage 2 cancer treatment. In general, stage 2 cancers tend to be treated locally with surgery and/or radiation therapy. Chemotherapy or other drugs may be used during stage 2 cancer treatment in some cases.
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What is the best treatment for stage 2 prostate cancer
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