Understanding Prostate Cancer

Learn more about how prostate cancer is staged and treated so you can make informed decisions about your care.

Prostate Cancer Screening and Diagnosis

It’s important to discuss prostate cancer screening with your doctor once you’re approximately 50 years old. By age 40, talk to your doctor about screening options. Your personal and family medical history might indicate that you need to begin regular screening sooner.

A consistently elevated Prostate-specific antigen (PSA) level is a sign that cancer could be growing. Your doctor may also perform a physical exam to feel the prostate. If your doctor has a concern, a biopsy is recommended. It’s the only test that can confirm a prostate cancer diagnosis.

A transrectal biopsy uses needles inserted through the rectum to remove several tissue samples (referred to as cores) from various areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells and writes a pathology report about what was found.

The Gleason Score and Prostate Cancer Grading

A Gleason score will be assigned to the two most predominant cell patterns found in the biopsy samples. Cells that look more like healthy cells receive lower scores, while more abnormal cells receive higher scores. The combined score will range from 2 to 10. Most physicians will consider pre-cancer or cancer starting at a Gleason score of 6 or more.

To simplify the understanding of Gleason scores, the Grade Group system was developed, assigning prostate cancers into 1-5 groups. Grade Group 1 corresponds to a Gleason score of 6 or less (low-grade), while Grade Group 5 corresponds to Gleason scores of 9 or 10 (high-grade).

Gleason 6: Typically referred to as Grade 1, the cells look similar to healthy cells (called well-differentiated), and treatment is not likely needed immediately.
Gleason 7: For this score, there is a difference between 3+4=7 and 4+3=7. When the three is first, the predominant cell pattern is slightly more normal than when the predominant pattern is a 4. The doctor may choose to monitor you closely for signs of cancer growth, or treatments may begin.

3+4=7 is considered Grade 2
4+3=7 is considered Grade 3

Gleason 8, 9, or 10: The cells look very different from healthy cells (they are called poorly differentiated or undifferentiated), and treatment is likely to start soon.

Gleason score of 8 is Grade 4
Gleason score of 9 or 10 is Grade 5

The PSA levels, Gleason score, and prostate cancer grade are related to how prostate cancer is staged.

At HOA, our team guides patients through every step of the diagnostic process, offering access to advanced imaging, biopsies, and pathology services to ensure precise diagnosis.

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Staging Prostate Cancer

After a prostate cancer diagnosis, your oncologist will determine the extent of your cancer. This process is known as staging, an essential part of treatment planning. Staging describes how far the cancer has advanced, including its location and whether it has spread (metastasized) beyond the prostate. If prostate cancer cells are affecting other parts of the body, it will be classified and treated as metastatic prostate cancer.

The Stages of Prostate Cancer

The stages of cancer range from I to IV (4 in Roman numerals), with a lower stage being easier to treat and a higher stage being more aggressive, requiring more treatments.

Stage I Prostate Cancer

Prostate cancer cannot be felt during a digital rectal exam and cannot be seen on a sonogram. It is typically found during surgery for another non-cancerous reason, usually benign prostatic hyperplasia (BPH). The cancer is confined to the prostate. PSA level is less than 10. The grade is G1, or the Gleason score is no higher than 6.

Stage II Prostate Cancer

The tumor is more advanced than Stage I but does not extend beyond the prostate. It may be felt during a digital rectal exam or seen on a sonogram.

Stage IIA Prostate Cancer: The tumor cannot be felt and involves half of one side of the prostate or less. The PSA level is at least 10 but lower than 20, Grade is 1, and the cancer cells are well-differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells remain well differentiated.

Stage IIB Prostate Cancer: The tumor is found only inside the prostate, and it may be large enough to be felt during a DRE. The PSA level is lower than 20, Grade is 2, and the cancer cells are moderately differentiated.
Stage IIC Prostate Cancer: The tumor is confined to the prostate, and it may be large enough to be felt during DRE. The PSA level is lower than 20, Grade is 3 or 4, and the cancer cells may be moderately or poorly differentiated.

Stage III Prostate Cancer

The tumor has grown outside of the prostate and may have invaded the seminal vesicles, but has not spread to the lymph nodes.

Stage IIIA Prostate Cancer: Cancer has spread beyond the outer layer of the prostate into nearby tissues and may have involved the seminal vesicles. PSA levels are at least 20 and Grade is 1, 2, 3, or 4.
Stage IIIB Prostate Cancer: The tumor has grown outside of the prostate and may have invaded nearby structures, such as the bladder or rectum. The PSA can be any level and Grade is 1, 2, 3, or 4.

Stage IIIC Prostate Cancer: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells. The PSA can be any level and Grade is 5.

Stage IV Prostate Cancer

The tumor has grown outside of the prostate and may have invaded the bladder, rectum, or nearby structures beyond the seminal vesicles, and may have spread to the lymph nodes, bones, or other parts of the body. In such cases, the new tumor retains the same type of abnormal cells and the same name as the primary tumor. As a result, the disease is classified as "distant" or metastatic prostate cancer and will be treated as prostate cancer.

Stage IVA Prostate Cancer: The cancer has spread to the regional lymph nodes. The PSA can be any level and the Grade is 1, 2, 3, 4, or 5.
Stage IVB Prostate Cancer: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.

Recurrent Prostate Cancer

Recurrent prostate cancer refers to prostate cancer that returns after treatment. In some cases, the recurrence occurs in the prostate area, while in others, it may develop in other areas of the body. If prostate cancer comes back, your oncologist will schedule additional tests to understand the extent of the recurrence. These tests will be similar to the ones done during the initial diagnosis of your prostate cancer.

Understanding Prostate Cancer Risk Groups

When creating a customized treatment plan for each prostate cancer patient, the risk of cancer growth and spread is considered, especially when determining the right time to start treatment. Patients are classified into risk groups based on their biopsy results, PSA levels, and digital rectal exam findings.

Prostate cancer is divided into three main risk groups:

Low Risk: Prostate cancer in this group grows slowly, remains confined to the prostate, and has a low PSA level (less than 10). These cancers are typically small, low-grade, and often cause no symptoms. Tumors that cannot be felt during a digital rectal exam or those with no cancer detected in two previous biopsies are classified as "very low risk."

Intermediate Risk: This group includes cancers confined to the prostate but with a higher PSA level (10-20) and Grade Groups 2 or 3. These cancers grow quicker than low-risk prostate cancers. Oncologists often divide this group into "favorable" and "unfavorable" intermediate-risk categories based on additional factors.

Favorable intermediate risk means that the Gleason score was 3+4=7 with a PSA less than 20, indicating slower growth, which might allow for delayed treatment.
Unfavorable intermediate risk means the Gleason score was 4+3=7, indicating a more abnormal primary cell pattern. Treatment usually needs to start immediately to prevent the cancer from growing outside the prostate.

High Risk: High-risk cancers typically spread beyond the prostate, with PSA levels above 20 or a Grade Group of 4 or 5. Tumors that extend to nearby areas like the seminal vesicles, rectum, or bladder, or those with multiple high-grade biopsy samples, are classified as "very high risk."

Find a Prostate Cancer Specialist in the Syracuse Area

At Hematology-Oncology Associates of CNY, we are committed to providing expert, patient-centered prostate cancer care. Our multidisciplinary team of specialists ensures that each patient receives a personalized treatment plan based on the latest advancements in prostate cancer care.

Our cancer centers offer care for patients in Central New York, in the Syracuse area, including Camillus and all of Onondaga County; Auburn, and the rest of Cayuga County; Oneida County, including Utica, Oneida, and Verona; Watertown, and throughout Oswego County.