Key takeaways
- Stage 3 prostate cancer means the cancer has grown outside the prostate gland but typically has not yet spread to distant organs, making it an advanced but often treatable condition.
- Diagnosis involves various tests, including a biopsy, PSA levels, and a Gleason score, which help determine the cancer’s aggressiveness and guide treatment decisions.
- Treatment options for stage 3 prostate cancer are effective and primarily focus on local treatments like surgery or radiation therapy, with ongoing advancements in treatment approaches.
Stage 3 prostate cancer is a locally advanced but still treatable form of the disease. Like other types of cancer, prostate cancer is classified in stages based on how far the disease has progressed.
Stage 1 prostate cancer means the cancer is still confined to the prostate gland, while stage 4 — the most advanced form of the disease — means the cancer has spread to other parts of the body. About 80 to 85 percent of all prostate cancers are diagnosed in stages 1, 2, or 3.
In stage 3, cancer cells have penetrated the thin capsule that surrounds the prostate gland. The malignant cells may have spread to tissue beyond the prostate, or the cancer may still affect the prostate only. The cancer has not spread to distant sites in stage 3.
Prostate cancers that are localized or regional — which includes stage 3 — have a nearly 100 percent 5-year relative survival rate. Individual prognosis, however, depends on tumor grade, PSA level, overall health, and treatment approach.
Early on, you may notice few if any prostate cancer symptoms. Most patients with localized prostate cancer will not have symptoms. Many people with localized disease are diagnosed through routine PSA testing rather than because they noticed symptoms.
As the cancer grows, some people may begin to notice urinary symptoms. These can include:
- a weak stream
- more frequent urination
- incontinence
- nocturia, or having to get up and pee in the middle of the night
- blood in your urine or semen
- feeling like you have to pee, but not passing anything
During stage 3, you may also experience pain or discomfort in the pelvic area. Erectile dysfunction may occur by stage 3.
If the doctor conducting a digital rectal exam feels any bumps or hard areas on the prostate, additional testing may be advised. In many cases today, a multiparametric MRI is performed before biopsy to look for suspicious areas and to help guide tissue sampling.
Prostate cancer requires a biopsy to confirm a diagnosis. A needle biopsy, in which a thin needle is inserted quickly into the prostate to obtain a small piece of tissue, is usually ordered if there are other indications of prostate cancer.
If cancer cells are found, they are assigned a Gleason score and grouped into a Grade Group (1 through 5), which helps estimate how aggressive the cancer is. Your doctor will also determine the cancer’s stage.
Treatment decisions are based on a combination of factors, including PSA level, tumor grade, stage, overall health, and personal preferences. A thorough discussion with your doctor to talk through the risks and benefits of each option is essential before choosing a treatment plan.
Describing a cancer in stages helps doctors and their patients identify the seriousness of the disease and how best to treat it.
Staging system
The system most commonly used is the TNM system, created by the American Joint Committee on Cancer. It’s based on how much the cancer has spread.
TNM system
- T to describe the extent of the primary tumor
- N to state whether the cancer has spread to the lymph nodes
- M to state whether the cancer has metastasized (or spread) to other tissue in the body
PSA levels
Doctors also rely on your PSA levels to help stage prostate cancer. PSA stands for prostate-specific antigen, a protein produced by the prostate.
PSA is measured in nanograms per milliliter of blood (ng/mL). Elevated PSA levels can be associated with prostate cancer, but they may also occur in noncancerous conditions such as benign prostatic hyperplasia (BPH), inflammation (prostatitis), or even after recent medical procedures.
PSA is interpreted alongside biopsy results, tumor grade, and imaging findings.
PSA results
Lower PSA values are generally considered safe. Most laboratories use a PSA of 4.0 ng/mL as the cutoff for “normal,” but each value must be considered in the appropriate clinical context.
Gleason score
Prostate cancer staging may also include a Gleason score, which is a way of estimating the aggressiveness of the cancer. A Gleason score is actually made up of two scores arrived at by examining a small sample of prostate tissue.
These two numbers are added together to create the Gleason score. For example, a Gleason score of 3 + 4 = 7 means the most common pattern is grade 3 and the second most common is grade 4. Higher numbers indicate more aggressive cancer.
Today, doctors also use a related system called the Grade Group (ranging from 1 to 5), which simplifies Gleason scoring and helps predict how the cancer may behave.
How the score looks
Each grade is a number between 1 and 5. You may have a Gleason score of 7, or a 3+4. The higher the score, the more aggressive the cancer is likely to behave.
Though there are variations within each stage, the following is a basic outline of the four stages of prostate cancer.
Stage 1
- The cancer is confined to the prostate gland and cannot be felt during a digital rectal exam or seen on imaging.
- In some cases, it may involve a very small, localized tumor within the prostate.
- PSA levels are often under 10 ng/mL, and the Gleason score is typically 6 (Grade Group 1).
- Prostate cancer that is localized to the prostate has a 5-year relative survival rate of nearly 100%.
Stage 2
- The cancer is still contained in the prostate.
- It may be felt during a digital rectal exam.
- PSA levels are generally under 20 ng/mL, though this can vary depending on the subtype.
- The Gleason score may range from 6 to 8 (Grade Groups 1–4), depending on the stage 2 classification.
- The 5-year survival rate is also nearly 100 percent.
Stage 3
The cancer is growing outside of the prostate gland, but may not have reached the rectum, bladder, or other organs. Stage 3 cancer is also divided into letter subgroups:
- Stage 3a. The cancer may or may not have grown outside the prostate. The PSA level is 20 ng/mL or higher. The Grade Group is 1 to 4 (Gleason score 8 or lower).
- Stage 3b. The tumor has grown through the outer capsule of the prostate or into nearby structures, such as the seminal vesicles. There is no lymph node or distant spread.
- Stage 3c. The tumor can be contained or is growing outside the prostate. There is no lymph node involvement. The PSA can be at any level and the Gleason score is a 9 or 10.
- If the cancer hasn’t spread far, the 5-year survival rate at stage 3 is still almost 100 percent.
Stage 4
- Stage 4 cancer is divided into letter subgroups depending on whether it has invaded the nearby lymph nodes (stage 4a) or whether it has reached distant lymph nodes or other organs, tissue, or even the bones (stage 4b).
- This is the most advanced form of prostate cancer.
- Any PSA level and Gleason score are possible.
- When prostate cancer has spread to distant parts of the body (stage 4b), the 5-year relative survival rate is about 30 percent.
What 5-year survival rates mean
It’s important to understand what survival rates mean. In this case, the number refers to the percentage of people who are still living five years after initial diagnosis. This means those people have lived at least five years after diagnosis. Many survival rates do not look beyond that timeframe.
Prostate cancer treatments range from active surveillance, which is a watch and wait approach to the slow-growing cancer, to invasive procedures. Procedures include surgery to remove the prostate and brachytherapy, which is the injection of radioactive “seeds” into the prostate to kill cancer cells.
Treatment options for stage 3 prostate cancer include:
- external beam radiation and hormone therapy
- external beam radiation and brachytherapy, along with hormone therapy
- radical prostatectomy, which is the surgical removal of the entire prostate and some surrounding tissue, including the seminal vesicles
- a pelvic lymph node dissection, which involves removing lymph node tissue
These approaches are known as “local” treatments because they treat the cancer in or close by the prostate gland.
A note about hope
Prostate cancer is usually a slow-growing cancer, so even if it is diagnosed at stage 3, there are very effective treatments available. And new developments in prostate cancer treatment are being made every year.
Prostate cancer is the
Because prostate cancer is slow growing, regular prostate screenings can often catch the disease in its early stages. The
- age 40 for men with more than one first-degree relative (brother or father) who had prostate cancer at an early age
- age 45 for men at high risk of developing prostate cancer, including African Americans and anyone with a first-degree relative who was diagnosed with cancer younger than 65 years of age
- age 55 to 69 for men who are of average risk of prostate cancer
The American Urologic Association advises regular prostate screening ever 2-4 years for those between 50 and 69 years.
The issue of prostate cancer screenings is a somewhat controversial one, so talk with a primary care physician or urologist about the pros and cons of getting a screening at your age.
Stage 3 prostate cancer, while an advanced form of the disease, can often be successfully treated. It may involve surgery or other procedures that can affect an individual’s urinary and sexual function.
However, stopping prostate cancer from potentially spreading throughout the body could be worth the costs of aggressive cancer treatment. Your age, health, and how prostate cancer and its treatment may affect your quality of life should be part of a thorough conversation with your doctor.