Editing Prostate cancer (section)

=== Staging ===
{{Main|Prostate cancer staging}}
[[File:Diagram showing T1-3 stages of prostate cancer CRUK 278.svg|thumb|left|Diagram showing T1 to T3 stages of prostate cancer |alt=Diagram of a prostate showing a small (T1), medium (T2), and large (T3) tumor.]]

After diagnosis, the tumor is [[cancer staging|staged]] to determine the extent of its growth and spread. Prostate cancer is typically staged using the [[American Joint Committee on Cancer]]'s (AJCC) three-component [[TNM staging system|TNM system]], with scores assigned for the extent of the tumor (T), spread to any lymph nodes (N), and the presence of [[metastases]] (M).<ref name=ACSStage>{{cite web |url=https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html |title=Prostate Cancer Staging |date=8 October 2021 |publisher=American Cancer Society |access-date=14 May 2023 |archive-date=15 May 2023 |archive-url=https://web.archive.org/web/20230515034626/https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html |url-status=live }}</ref> Scores of T1 and T2 represent tumors that remain within the prostate: T1 is for tumors not detectable by imaging or digital rectal exam; T2 is for tumors detectable by imaging or rectal exam, but still confined within the prostate.{{sfn|Scher|Eastham|2022|loc="Table 87-1 TNM classification"}} T3 is for tumors that grow beyond the prostate – T3a for tumors with any extension outside the prostate; T3b for tumors that invade the adjacent [[seminal vesicle]]s. T4 is for tumors that have grown into organs beyond the seminal vesicles.{{sfn|Scher|Eastham|2022|loc="Table 87-1 TNM classification"}} The N and M scores are binary (yes or no). N1 represents any spread to the nearby lymph nodes. M1 represents any metastases to other body sites.{{sfn|Scher|Eastham|2022|loc="Table 87-1 TNM classification"}}

The AJCC then combines the TNM scores, Gleason grade group, and results of the PSA blood test to categorize cancer cases into one of four stages, and their subdivisions. Cancer cases with localized tumors (T1 or T2), no spread (N0 and M0), Gleason grade group 1, and PSA less than 10&nbsp;ng/mL are designated stage I. Those with localized tumors and PSA between 10 and 20&nbsp;ng/mL are designated stage II – subdivided into IIA for Gleason grade group 1, IIB for grade group 2, and IIC for grade group 3 or 4. Stage III is the designation for any of three higher risk factors: IIIA is for a PSA level about 20&nbsp;ng/mL; IIIB is for T3 or T4 tumors; IIIC is for a Gleason grade group of 5. Stage IV is for cancers that have spread to lymph nodes (N1, stage IVA) or other organs (M1, stage IVB).<ref name=ACSStage/>
{| class="wikitable floatright" style="text-align:center;font-size:90%;margin-left:1em;"
|+AJCC stage for prostate cancer
!AJCC Stage
!TNM scores
!Gleason grade group
!PSA
|-
|Stage I
|T1 or T2, N0, M0
|1
|<10&nbsp;ng/mL
|-
|Stage IIA
| rowspan="3" |T1 or T2, N0, M0
|1
| rowspan="3" |10-20&nbsp;ng/mL
|-
|Stage IIB
|2
|-
|Stage IIC
|3 or 4
|-
|Stage IIIA
|T1 or T2, N0, M0
| rowspan="2" |3 or 4
|> 20&nbsp;ng/mL
|-
|Stage IIIB
|T3 or T3, N0, M0
| rowspan="2" |10–20&nbsp;ng/mL
|-
|Stage IIIC
|T1 or T2, N0, M0
|5
|-
|Stage IVA
|Any T, N1
| rowspan="2" |Any group
| rowspan="2" |Any PSA
|-
|Stage IVB
|Any T, M1
|}

The United Kingdom [[National Institute for Health and Care Excellence]] recommends a five-stage system based on disease prognosis called the Cambridge Prognostic Group, with prognostic groups CPG&nbsp;1 to CPG&nbsp;5.<ref name=":2">{{cite web |title=Prostate Cancer: Diagnosis and Management. NICE Guideline [NG131] |url=https://www.nice.org.uk/guidance/ng131/chapter/Recommendations#assessment-and-diagnosis |access-date=3 October 2022 |website=National Institute for Health and Care Excellence (NICE) |date=9 May 2019 |archive-date=11 August 2023 |archive-url=https://web.archive.org/web/20230811131224/https://www.nice.org.uk/guidance/ng131/chapter/Recommendations#assessment-and-diagnosis |url-status=live }}</ref> CPG&nbsp;1 is the same as AJCC stage I. Cases with localized tumors (T1 or T2) and either Gleason grade group 2 or higher PSA levels (10 to 20&nbsp;ng/mL) are designated CPG&nbsp;2. CPG&nbsp;3 represents either Gleason grade group 3, or the combination of the CPG&nbsp;2 criteria. CPG&nbsp;4 is similar to AJCC stage 3 – any of Gleason grade group 4, PSA levels above 20&nbsp;ng/mL, or a tumor that has grown beyond the prostate (T3). CPG&nbsp;5 is for the highest risk cases: either a T4 tumor, Gleason grade group 5, or any two of the CPG&nbsp;4 criteria.<ref>{{cite web |url=https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/cambridge-prognostic-group-cpg |access-date=25 June 2023 |title=Prostate Cancer Risk Groups and the Cambridge Prognostic Group (CPG) |publisher=Cancer Research UK |date=24 May 2022 |archive-date=11 August 2023 |archive-url=https://web.archive.org/web/20230811132255/https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/cambridge-prognostic-group-cpg |url-status=live }}</ref>