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Cancers are staged based on the amount of cancer cells and how much they have spread. The cancer might remain only in the prostate gland (local), spread to nearby areas (regional), or other organs (metastatic). If the cancer is still in or on the surface of the prostate, meaning that it’s localized, our doctors assign it a risk group, which indicates how quickly it may grow or spread. Based on this insight, they also determine treatment method and timing.

Local (Stages 1 and 2)

Local prostate cancer is in one or both sides of the prostate. It has not spread to the lymph nodes or anywhere else in the body. If the tumor is small and only located on one side of the prostate, the cancer may be at low risk of spreading or causing health problems. If it’s in more than half of one side or both sides of the prostate, the risk may be higher.

Regional (Stage 3)

The cancer has spread to areas outside the prostate, such as the seminal vesicles, the sacs located behind a man’s bladder and in front of his rectum, or other tissues next to the prostate. This type of cancer may have a high to very high risk of growing or spreading to lymph nodes and other areas of the body.

Metastatic (Stage 4)

Cancer that is metastatic has spread to other areas of the body, such as distant lymph nodes, bones, or other organs. In these cases, cancer cells have separated from the original tumor and spread to other areas of the body via the bloodstream or lymphatic system. NYU Langone doctors work closely with patients to ensure they understand the status of their cancer and the treatment options available.

Local prostate cancer is in one or both sides of the prostate. It has not spread to the lymph nodes or anywhere else in the body. If the tumor is small and only located on one side of the prostate, the cancer may be at low risk of spreading or causing health problems. If it’s in more than half of one side or both sides of the prostate, the risk may be higher.

The Gleason score is another system used to understand a patient’s cancer and determine an appropriate treatment plan. A biopsy is taken, and tumor cells are examined under a microscope by pathologists. The cells are then assigned a number based on their appearance. This indicates how likely the cancer is to spread.

First, pathologists look at the largest cancer area and assign that region a score from 1 (not aggressive) to 5 (very aggressive). Next, they look at the second-largest cancerous area and assign it a score from 1 to 5. The Gleason score is the sum of those two numbers.

For instance, the grades might be written as 3 + 4 = 7, or an overall Gleason score of 7. It’s important to note that there can be a difference in the progression of a 3+4 versus a 4+3, even though both have a Gleason score of 7. A 3+4 may grow slowly, while a 4+3 may have steady, consistent growth.

Grade groups may also be used in place of Gleason scores.

Combining the two scoring systems can look like the following:

• Gleason score of 6 or below (Grade 1): The tumor cells resemble normal prostate cells, which means they’re less likely to spread.
• Gleason score 7 (Grade 2): Most of the cells look like normal prostate cells, which means the cancer may grow slowly.
• Gleason score 7 (Grade 3): The tumor cells look less like normal prostate cells, indicating they may grow steadily over time.
• Gleason score 8 (Grade 4): The tumor cells don’t look normal. The cancer may grow at a steady or rapid pace.
• Gleason score 9 or 10 (Grade 5): The tumor cells look very abnormal, and the cancer may grow rapidly.

Doctors at NYU Langone’s Perlmutter Cancer Center tailor treatment plans to each person and their stage and grade of cancer.

These are some of the cancer treatment options our doctors recommend:

• active surveillance, which is ideal for small or slow-growing prostate cancers unlikely to cause serious consequences
• hormone therapies and other systemic therapies, ideal for treating prostate cancer that has spread or returned after surgery or radiation therapy
• minimally invasive ablation treatment, ideal for treating cancer that is only in a small area of the prostate
• radiation therapy, ideal for managing cancers confined to the prostate and surrounding tissues radioligand therapy, ideal for treating men with advanced prostate cancer that has spread to other areas of the body, despite undergoing other cancer treatments
• surgery, ideal for treating men who have cancer that hasn’t spread to the lymph nodes NYU Langone doctors look at the whole person—not just the cancer—when determining the right treatment plan. We consider potential treatment side effects, as well as your age, general health, personal preferences, and quality of life.

NYU Langone doctors look at the whole person—not just the cancer—when determining the right treatment plan. We consider potential treatment side effects, as well as your age, general health, personal preferences, and quality of life.