Early prostate cancer usually causes no symptoms, but can include blood in the urine or semen. The outlook is often excellent, especially if doctors diagnose it in the early stages.

Prostate cancer is the second most common cancer in males in the United States.

In 2022, the American Cancer Society (ACS) expects that around 268,490 people will have a new diagnosis of prostate cancer and around 34,500 people will die from the disease.

The outlook for prostate cancer is usually good. In the early stages, prostate cancer is highly treatable, and many people receive effective treatment.

However, if a person receives a diagnosis at a late stage, the cancer may be more difficult to treat.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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There are different ways of classifying cancer stages, including prostate cancer. Staging is when a doctor decides how far cancer cells have progressed and how much they may have spread.

Doctors determine the stage using the prostate-specific antigen (PSA) and the Gleason score.

PSA is a protein that appears at higher levels in the bloodstream when there is a problem with the prostate. The Gleason system can also help determine the stage by classifying cancer cells, which can act differently.

Some stages are more aggressive and can spread more easily. The Gleason score includes a calculation of how likely a tumor will spread and how quickly it will do so. This is called the grade.

Here is a brief overview of each stage of prostate cancer.

StageGrade GroupPSAGleason scoreCancer location
11less than 10 ng/mL6 or lessprostate
2A110–20 ng/mL6 or lessprostate
2B210–20 ng/mL7 (3 + 4)prostate
2C3 or 410–20 ng/mL7 (4 + 3) or 8prostate
3A1–4at least 20 ng/mL8 or lessprostate
3B1–4any8 or lessprostate and surrounding tissues
3C5any9 or 10prostate and possibly surrounding tissues
4Aanyanyanyprostate, lymph nodes, and possibly surrounding tissues
4Banyanyanyprostate, other parts of the body, and possibly surrounding tissues and lymph nodes

A simpler way to stage cancer is to look at how far it has spread from its original site. These stages are:

  • Localized cancer: Cancer cells remain in the area where they started. In this case, within the prostate gland.
  • Regional cancer: Cancer has spread to nearby tissues and possibly nearby lymph glands, but not to other parts of the body.
  • Distant cancer: Cancer has spread throughout the body and affects other organs, such as the lungs or liver.


It is difficult to identify specific prostate cancer symptoms by stage. Many people may be asymptomatic until a late stage. Sometimes, other conditions such as benign prostatic hyperplasia (BPH) can cause similar symptoms.

The symptoms also depend on whether cancer has spread beyond the prostate and what part of the body it has affected.

However, the symptoms are likely to be very particular when they do occur. If a person experiences any of the following, they should seek an evaluation with a doctor:

  • needing to urinate more frequently, especially at night
  • increased urgency to urinate
  • changes in urine flow
  • a feeling of incomplete emptying of the bladder
  • blood in the urine or semen

Below the article goes into more detail about each prostate cancer state.

Technically, there can be a precursor stage before prostate cancer develops.

Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia (PIN) or carcinoma in situ by the time they are 50 years old. PIN occurs when there are changes in the cells that line the prostate gland.

PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.

In this stage of prostate cancer, there are cancerous cells, but the tumor is small and only affects one area.

The PsA level at this stage is less than 10 nanograms per milliliter (ng/ml). The Gleason score is 6 with a grade of 1.

A digital rectal exam (DRE) or ultrasound will not reveal a tumor. However, routine screening can detect cancer at this stage, making early treatment possible.


There are often no noticeable symptoms at this stage. When symptoms do occur, they may be similar to BPH, a condition characterized by the enlargement of the prostate gland.

In stage 2 prostate cancer, cancer has not spread beyond the prostate gland, and medical tests may not reveal a tumor. However, as this stage progresses, a doctor may detect changes during a digital rectal examination (DRE) or a rectal ultrasound.

The PSA score is between 10–20 ng/ml. An early stage 2 tumor is grade 1, rising to 3 in the later phases of stage 2. The Gleason score is 6 and rising to 7 or 8.


Symptoms are more likely to occur once cancer has grown large enough to put extra pressure on the urethra, which is the tube that transports urine from the bladder out of the penis.

At this stage, cancer has spread beyond the prostate gland. It may have reached the seminal vesicles, the glands that secrete a fluid that helps make up the semen. However, it has not reached the bladder or the rectum.

The PSA can be any value over 20 ng/ml. The grade group is 1–4 at first and as high as 9–10 at the end of stage 3.


If a person has not received treatment for the prostate itself at this stage, they may experience many of the typical symptoms, including changes in the flow and frequency of urination.

Additionally, a person might also experience other symptoms, depending on how much cancer has spread and the specific areas it has affected.

This may include unintentional weight loss and feelings of fatigue or weakness.

At stage 4, cancer has spread to other areas, including nearby organs, such as the bladder, rectum, or lymph nodes. It may have also spread to distant organs, such as the bones or the liver.

When prostate cancer spreads to other parts of the body, it is called metastatic prostate cancer.

The grade group, Gleason score, and PSA levels can be any number at this point.


The metastatic prostate cancer symptoms depend on the tumor size and the other affected areas. A person may begin to experience pain in different parts of the body, especially if cancer has spread to the bones.

Many other conditions can cause symptoms that may mimic certain symptoms of prostate cancer.

For example, BPH is a condition in which the prostate becomes enlarged. This can put extra pressure on the urethra, causing issues with urination similar to those associated with prostate cancer.

BPH usually affects older adults. In fact, it affects around 50% of males ages 60 and older.

Treatment often involves a combination of lifestyle changes and medications. Certain surgical procedures may also be necessary if other treatment options are ineffective.

Prostatitis, also known as prostate inflammation, is another condition that affects the prostate gland.

Symptoms can vary depending on the specific type of prostatitis, but the condition usually causes issues like painful urination, difficulty emptying the bladder, increased frequency of urination, and painful ejaculation.

A bacterial infection can cause prostatitis. Other causes can be stress, injury, or prior urinary tract infections.

To diagnose prostate cancer, a doctor will ask about a person’s medical history and any symptoms that they are experiencing.

They may also conduct a physical exam, along with a digital rectal exam. This procedure involves inserting a gloved and lubricated finger into a person’s rectum to determine whether there are any areas on the prostate that could be cancerous.

A doctor may order a blood test to measure levels of PSA, a type of protein used to screen for prostate cancer.

A doctor will usually also recommend a prostate biopsy in order to get a definitive diagnosis. This involves collecting a small sample of the prostate using a hollow tube and sending the sample to a lab to check for cancer cells.

If a person experiences any of the symptoms of prostate cancer, such as changes in the flow or frequency of urination, it is important to talk with a doctor.

While these symptoms could also occur due to other conditions, such as BPH or prostatitis, a doctor can help determine the cause and best course of treatment.

Even without obvious symptoms, a person may also want to discuss getting screened for prostate cancer with a doctor. This can be especially beneficial for people at a higher risk of developing prostate cancer, including those with a first-degree relative who had prostate cancer at an early age.

Effective treatment is often possible for prostate cancer, especially if a person receives a diagnosis in the early stages.

If tests show that prostate cancer is present, the doctor will discuss treatment options with the individual. Factors affecting the decision will include:

  • the stage and grade of the cancer
  • the person’s age and overall health
  • personal preferences

Options include:

  • Watchful waiting: The person will attend regular health checks to monitor for further changes, and the doctor will take periodic tests of the person’s PSA levels.
  • Surgery: It may be necessary to remove the prostate gland.
  • Radiation therapy: This can help reduce the size of a tumor and kill cancer cells after surgery. Methods include directing an external beam of radiation at the affected area or introducing radioactive material in the area where cancer is present.
  • Hormone therapy: In some cancers, high levels of certain hormones can encourage cancer growth. Blocking these hormones can help slow or stop the growth.
  • Chemotherapy: Doctors prescribe drugs that kill cancer cells either throughout the body or in a specific area. Chemotherapy is an effective treatment, but it targets both healthy and unhealthy cells and can lead to severe adverse effects.
  • Immunotherapy: A vaccine treatment can boost the immune system or direct it to attack cancer cells.
  • PARP inhibitors: These medications block the actions of certain enzymes that help cancer cells repair and grow. Doctors typically use these in stage 4 metastatic prostate cancer.

Some newer treatments include:

  • Cryotherapy: This uses very cold temperatures to kill early-stage cancer cells.
  • High-intensity focused ultrasound therapy: A doctor uses a rectal probe to deliver ultrasound waves. The waves destroy the cancer cells.
  • Proton beam radiation therapy: Thisis another type of radiation therapy that targets cancer cells.
  • Photodynamic therapy: This combines the use of a drug with laser light to kill cancer cells in a specific area.

Other treatments can help manage symptoms, such as pain relief medication or drugs to help strengthen the bones.

A around 1 in 8 males will receive a diagnosis of prostate cancer in their lifetimes. However, only about 1 in 41 males will die from prostate cancer.

According to the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute (NCI), a person living with prostate cancer has the following chance of surviving at least 5 years after diagnosis:

  • Localized: nearly 100%
  • Regional: nearly 100%
  • Distant: 31%
  • Overall: 98%

While the outlook is very good, especially in the early stages, the outcome for any individual will depend on various factors. These include the person’s age, overall health, and type of cancer, among others.

After treatment, the individual may need to continue to see a doctor for some time. A doctor will monitor PSA levels and other indicators, which could indicate that the cancer is recurring or coming back. Following the treatment plan can help a person stay healthy.

Males and anyone who was assigned male at birth should ask a doctor about their risk levels and screening options. Routine screening can help detect prostate cancer at an early stage when it is highly treatable.

Doctors do not yet know how transitioning from male to female may affect the chances of prostate cancer, but there may be a risk. For this reason, anyone who was born with a prostate gland should continue to receive monitoring for prostate cancer.

Here are a few answers to additional, common questions about prostate cancer.

How do you know at what stage your prostate cancer is?

A doctor can determine the stage of prostate cancer by considering several factors, including a person’s PSA levels, Grade Group, the extent of the primary tumor, the structure of the tumor based on microscopic analysis, and whether the cancer has spread to the lymph nodes or other parts of the body.

How fast does prostate cancer progress?

In most cases, prostate cancer tends to grow slowly over the course of many years. However, this may vary depending on many factors, including the stage and grade group of cancer.

How does prostate cancer cause death?

When diagnosed early, prostate cancer has an excellent outlook, and doctors can often treat it successfully. However, advanced prostate cancer can spread to other parts of the body such as the bones, lymph nodes, liver, or lungs. This can interfere with a person’s ability to function, which can ultimately be fatal.

At what age should I start screening for prostate cancer?

Males who do not have symptoms that may indicate prostate cancer should get a screening if they are over age 40, have a family history of cancer, carry known BCRA mutations, or are African American. If a person does not fit these criteria, they should still be screened after age 45.

Prostate cancer is a common type of cancer that affects the prostate gland and can cause symptoms like changes in urine flow, pain, or difficulty passing urine.

Several different stages vary depending on how far cancer has spread from the original site.

However, the overall outlook for prostate cancer is excellent, especially if the person receives a diagnosis and treatment early.