Prostate cancer staging

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Prostate cancer staging is the process by which physicians categorize the risk of cancer having spread beyond the prostate, or equivalently, the probability of being cured with local therapies such as surgery or radiation. Once patients are placed in prognostic categories, this information can contribute to the selection of an optimal approach to treatment. Prostate cancer stage can be assessed by either clinical or pathological staging methods.^[1] Clinical staging usually occurs before the first treatment and tumour presence is determined through imaging and rectal examination, while pathological staging is done after treatment once a biopsy is performed or the prostate is removed by looking at the cell types within the sample.^[1]

There are two schemes commonly used to stage prostate cancer in the United States. The most common is promulgated by the American Joint Committee on Cancer (AJCC), and is known as the TNM system, which evaluates the size of the tumor, the extent of involved lymph nodes, and any metastasis (distant spread) and also takes into account cancer grade.^[2] As with many other cancers, these are often grouped into four stages (I–IV). Another scheme that was used in the past was Whitmore-Jewett staging, although TNM staging is more common in modern practice.^[3]

In the United Kingdom the 5-tiered Cambridge Prognostic Group (CPG) is used, replacing a previous system that divided prostate cancer into three risk groups.^[4]