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The T along with a number designates the size and invasiveness of the tumor. The number increases with tumor size and extent of invasiveness. For example, a small lesion confined to the prostate would be written as T1; larger tumor size or deeper extension into nearby organs or tissues is a T2; larger tumor size or extension beyond the organ of origin but confined to the region is a T3; and a massive tumor or one that directly invades another organ or tissue is a T4.

The pathologic T stage assigned after surgery can help physicians more accurately predict the patient's outlook for survival. Some T stages reflect findings made only after a radical prostatectomy (surgery to remove the prostate gland, seminal vesicles and nearby tissues).

T Staging

There are 4 categories for describing the prostate cancer's T stage:

T1 (Stage I)

T1 refers to a tumor that is not felt during a digital rectal exam, but cancer cells are found in a prostate biopsy or prostatectomy specimen. T1 prostate cancers can be further sub-classified as T1a, T1b and T1c.

• T1a describes prostate cancers found by "accident" during a transurethral resection of the prostate (TURP), a surgical procedure to relieve symptoms of benign prostate enlargement. This operation is usually done because the enlarged prostate gland presses on the urethra and makes it difficult for a man to urinate. When prostate tissue is removed and checked under the microscope, cancer may be found, even though the doctor who removed the tissue did not expect cancer to be present. T1a means that less than 5% of the tissue removed is cancerous and more than 95% is benign (free of cancer).
• T1b also describes cancers found by accident during TURP, but more than 5% of the tissue removed is cancerous.
• T1c cancers are found by biopsy. In these cases, the biopsy is usually done because the PSA level was elevated, suggesting that a cancer might be present. This staging comprises the majority of prostate cancers detected in the United States today.

T2 (Stage II)

T2 means that a doctor can feel an enlarged prostate by digital rectal exam, or DRE, and that the cancer is most likely contained within the prostate gland. This stage is also called the clinical and/or pathologic stage because it is based on the findings of a nodule felt by a doctor during a DRE and/or it is based on the pathology results after a radical retropubic prostatectomy (confined within the prostate). This category is sub-classified into T2a, T2b and T2c.

• T2a means that the cancer is in only the right or left side of the prostate, but not both sides, and is in only half (or less) of that side.
• T2b cancers are in only one side of the prostate, but are in more than half of that side.
• In T2c cancer, the cancer is in both the left and right sides.

T3 (Stage III)

T3 cancers have spread beyond the outer rim (capsule) that surrounds the prostate. The cancer has reached the connective tissue next to the prostate and/or the seminal vesicles but does not involve any other organs. This group is divided into T3a and T3b.

• In T3a, the cancer is growing outside the prostate. It has not spread to the seminal vesicles.
• A T3b cancer has spread to the seminal vesicles.

T4 (Stage IV)

T4 means that the cancer has spread to tissues next to the prostate (in addition to or other than the seminal vesicles), such as the bladder neck or its external sphincter (muscles that help control urination), the rectum, the muscles in the pelvis or the wall of the pelvis.

N Stages

The N Stages are categories for describing prostate cancer levels in the lymph nodes:

Nx means that testing has not been performed to detect if cancer has spread to the lymph nodes.

N0 means that the cancer has not spread to any lymph nodes.

N1 means the cancer has spread to nearby lymph nodes in the pelvis.

M Stages

The M Stages are categories for describing prostate cancer that has metastasized (spread) to other sites in the body, called distant spread or metastasis:

Mx means that testing has not been performed to detect if cancer has spread to distant organs.

M0 means that the cancer has not spread beyond the regional lymph nodes.

M1 means the cancer has spread beyond the regional lymph nodes to distant sites.

• M1a means the cancer has spread to distant lymph nodes.
• M1b means the cancer has spread to bone(s).
• M1c means the cancer has spread to other areas such as lungs, liver or brain.

Classifications of Prostate Cancer

In addition to the staging, men who are diagnosed with prostate cancer are classified into one of the groups below.

• Clinically localized disease (prostate cancer confined to the prostate)
• Locally advanced disease (prostate cancer spread to the outer rim of the prostate gland)
• Prostate cancer that has spread to regional lymph nodes, but not surrounding soft tissue or bones
• Metastatic disease (prostate cancer that has spread to other parts of the body, including the bones)

For more information about prostate cancer treatment and prevention at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427).