Prostate Cancer - Phase 1

Natural History

Clinical Features

Tumour Features


Prostate carcinoma is staged with the AJCC TNM classification with several added factors.

Tumour Factors

The spread of cancer within and beyond the cancer defines the T stage

  • T1 disease is asymptomatic and clinically undetectable and found on biopsy of the prostate (either TURP specimen or transrectal ultrasound biopsy)
  • T2 disease is located within the prostate but does not penetrate the prostate capsule.
  • T3 disease extends through the capsule (T3a) or into seminal glands (T3b)
  • T4 disease extends into extraprostatic structures such as the bladder or rectum.

Lymph Nodes

Distant Metastatic Disease

Metastatic disease is the most important indicator of prognosis.

  • M0 disease has no distant metastatic disease
  • M1 disease has distant metastates present

Gleason Score

The Gleason Score (described above) is another prognostic factor used in staging of prostate cancer.

  • Gleason scores of 6 or less are low risk
  • Gleason scores of 7 are intermediate risk
  • Gleason scores of 8 and above denotes a high risk


The PSA level is another important prognostic factor.

  • PSA < 10 is associated with a low risk
  • PSA of 10 - 20 is intermediate risk
  • PSA of > 20 is high risk disease