Prostate Cancer Grading and Staging | Explained by Australian Urologist Expert

Prostate cancer is the most common cancer affecting men in Australia. It is a cancer arising from the prostate gland which is located between the bladder and the penis, deep in the pelvis. Staging and grading is very important so doctors can ‘risk stratify’ men depending on whether their cancer is not very aggressive, aggressive or somewhere in between. So what do we mean by the terms Staging and Grading?…

Here we share a video extract from the Navigate trial website where urologist, Prof Declan Murphy, explains the stages and grades of prostate cancer and what this means for treatment options.

Text version of recorded audio:

Prostate cancer is the most common cancer affecting men in Australia. It’s a cancer that arises from the prostate gland, which is located between the bladder and the penis deep in the pelvis.

It affects about 20,000 men per year in Australia and accounts for about 3,000 deaths.

Staging and grading of prostate cancer are very important so that we can risk stratify men depending on whether their cancer is not very aggressive, very aggressive or somewhere in between.

So what do we mean by these terms?

First of all, staging employs the location of the cancer with respect to the prostate gland.

So is it confined deep in the prostate gland coming towards the end edge of the prostate gland or has it extended beyond the prostate gland?

The term we use to describe staging of prostate cancer is the T stage.

A cancer which is confined deep in the prostate and can’t be felt when we examine the prostate is a T1 cancer. A T2 cancer is a cancer that we can feel when we put a finger in the rectum to examine the prostate but it has not spread beyond the prostate, and a T3 prostate cancer is staged as a cancer which is spreading through the prostate towards adjacent structures.

The grade of the prostate cancer is something we establish following a biopsy of the prostate.

When the pathologist receives biopsy samples from the prostate, he or she will examine these under a microscope and assign a grade to the cancer.

Cancers can be graded as ‘low grade’ if they are not very aggressive, ‘intermediate grade’ if they are moderately aggressive and ‘high grade’ if under the microscope they have features which are suggestive of aggressive types of prostate cancer.

So when we combine these things, the staging of cancer based on examination and the grading of cancer based on the microscopic examination, we can establish whether a patient is at low risk of the cancer progressing, intermediate risk or high risk and this is critically important in considering the choices of whether to have treatment or not.

The pathologist will assign a Gleason score, Gleason being the term we use to describe the aggressiveness of the cancer, to the biopsy specimens. A Gleason score of 6 is a low-risk cancer not likely to progress quickly. A Gleason score of 7 is an intermediate risk cancer somewhat more at risk of progressing, and a Gleason 8, 9 or 10 cancer is at high risk of progression.

Combining stage in grade allows us to speak to patients about their management options based on the likelihood of their cancer being a significant threat.

Once a diagnosis of prostate cancer is made and we understand the stage and grade of the cancer, the next thing to consider is the natural history of that cancer.

This is important in prostate cancer as many prostate cancers are low grade, low stage and therefore have a low risk of progressing to more advanced stages. Other cancers that are higher grade or higher stage are at risk of spreading beyond the prostate and causing significant issues.

Once we establish the stage and grade of cancer, then we can counsel patients more accurately about the likely progression of their cancer if left untreated.

Many men with low risk cancer are at very low risk of progression and these men can be managed safely with active surveillance.

Men at higher risk of progression can consider active treatments such as surgery or radiotherapy.

If you are reading this article before October 2020 and have recently been diagnosed with early-stage, low-risk prostate cancer, please consider joining our research trial www.navigateprostate.com.au to help navigate your treatment options.

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