A Comprehensive Guide to the Stages of Prostate Cancer

Prostate cancer is the second most common cancer among men in Singapore. Understanding its stage and grade is crucial for guiding treatment decisions, planning follow-up care and setting realistic expectations for recovery. By learning about these factors early, patients and their families can feel more informed and prepared for the tests, timelines and choices ahead.

How Is the Cancer Stage Determined?

Accurate staging relies on a combination of several tests. Combining these results provides a clear view of whether the cancer is localised, locally advanced or metastatic.

• PSA Test: A blood test that measures prostate-specific antigen. Higher levels can indicate a greater likelihood of significant disease, though PSA alone is not diagnostic.

• Prostate Biopsy: Tissue samples are examined under a microscope to confirm the diagnosis and assess the Gleason score (or Grade Group), which helps determine how aggressive the cancer is.

• Clinical Examination: A digital rectal examination (DRE) allows a clinician to assess the size and firmness of the prostate.

• Imaging Test: Scans such as MRI, CT or bone scans help show whether cancer has spread beyond the prostate.

The TNM Staging System

The TNM system is an internationally recognised framework that forms the basis of clinical decision-making for most types of cancer, including prostate cancer. The TNM system records three elements which help urologists describe how far the cancer has spread and supports consistent treatment planning.

• T (Tumor) – Describes the size and local spread of the tumour within or beyond the prostate

• N (Nodes) – Indicates whether nearby lymph nodes contain cancer

• M (Metastasis) – Shows whether cancer has spread to distant parts of the body, commonly the bone or lung.

Combining these elements with prostate-specific antigen (PSA) and the tumour grade produces a stage group that ranges from I to IV.

Stages of Prostate Cancer

Prostate cancer is classified into four main stages, based on how far the disease has spread and how aggressive it appears. These stages help doctors plan the most appropriate treatment and give patients a clearer idea of what to expect throughout their care journey.

• Stage I

  Stage I prostate cancer is small and confined to the prostate. It is often detected early through PSA testing, DRE or biopsy for another reason. Tumours at this stage usually have low PSA levels and a low grade, and many grow very slowly.

  Active surveillance may be recommended, involving regular PSA testing, MRI scan and repeat biopsies when needed, especially for men with other health conditions.

• Stage II

  Stage II prostate cancer remains within the prostate but involves a larger tumour or a greater portion of the gland compared to Stage I. PSA values and tumour grade are often higher, indicating a greater risk of progression.

  Treatment options at this stage may include radical prostatectomy or radiotherapy. The choice depends on factors such as age, overall health, tumour grade and personal preferences.

• Stage III

  Stage III prostate cancer has spread beyond the prostate capsule to nearby tissues, such as the seminal vesicles, but usually has not reached the lymph nodes or distant organs.

  Management typically involves combined treatments, such as radiotherapy with hormonal therapy, or surgery followed by additional therapies to reduce the risk of recurrence.

• Stage IV

  Stage IV prostate cancer has spread to regional lymph nodes, distant organs or both. The most common sites of spread are bones and, less frequently, soft tissues or the lungs.

  Treatment at this stage focuses on controlling cancer growth, relieving symptoms and maintaining quality of life. Options may include hormonal therapy, chemotherapy, radiotherapy or targeted treatments.

Conclusion

Prostate cancer varies from indolent tumours that can be monitored safely to aggressive disease that needs prompt systemic therapy. Knowing both stage and grade gives patients the best chance of receiving appropriate, timely care.

If you or a loved one is at risk or if you have been diagnosed with early-stage disease, discussing these details with a prostate cancer specialist will help identify the most suitable path forward. contact our clinic for proper guidance.