What Stage Is My Prostate Cancer and What Are My Treatment Options?

Q: What is the life expectancy of a person with prostate cancer?

Life expectancy for prostate cancer depends on the stage and grade of the cancer, the man's age and overall health, and the treatment received. For early-stage prostate cancer (Stage 1 and 2), the five-year survival rate is near 100% according to Cancer Research UK. Stage 3 prostate cancer has an approximately 95% five-year survival rate. For men with localised disease treated with focal therapy at The Focal Therapy Clinic, an audit of 265 patients shows 90% remained cancer-free at one year, with 97% maintaining urinary continence and 90%+ preserving sexual function.

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Medically Approved by Dr Aqua Asif (12/5/2025) and Mr Tim Dudderidge Consultant urologist GMC: 4505451 (24/3/2026)

Written by FTC Medical team

At a Glance

Prostate cancer is staged from 1 to 4 using the TNM system, Gleason grading, and PSA levels. Most men are diagnosed at an early stage (Stage 1 or 2), where the cancer is confined to the prostate and the five-year survival rate approaches 100%. For men with localised, early-stage prostate cancer, focal therapy — including NICE-approved HIFU (IPG424) and NanoKnife IRE (IPG768) — can treat the tumour while preserving sexual function in 90%+ of cases (FTC audit, n=265).

Key takeaways:

Four numbered stages — Stage 1 (confined, often no symptoms) through Stage 4 (spread beyond the prostate to bones or organs)
TNM plus Gleason grading — staging combines tumour size (T), lymph node status (N), distant spread (M), and how aggressive the cells appear under a microscope
Early stages are highly treatable — five-year survival for Stage 1–2 is near 100%, with treatment options including active surveillance, focal therapy, surgery, and radiotherapy
Focal therapy for localised disease — HIFU and NanoKnife IRE target the tumour only, with 97% urinary continence and 90%+ sexual function preservation (FTC audit, n=265)
Staging guides your treatment pathway — your consultant uses your stage, grade, and PSA to recommend the most appropriate treatment for your specific situation

If you have been diagnosed with prostate cancer, one of the first things your consultant will explain is the stage — how far the cancer has progressed and what it means for your treatment options. The good news is that the majority of prostate cancers are diagnosed at an early stage, when treatment is highly effective and a wide range of options are available.

At The Focal Therapy Clinic, our consultant urological surgeons use detailed staging information alongside mpMRI and targeted biopsy results to recommend the most appropriate treatment for each patient. For men with localised, early-stage prostate cancer, focal therapy — including NICE-approved HIFU (IPG424) and NanoKnife IRE (IPG768) — offers cancer control with significantly fewer side effects than radical surgery or radiotherapy.

How Is Prostate Cancer Staged?

Prostate cancer staging describes how large the tumour is, whether it has spread to lymph nodes, and whether it has metastasised to other parts of the body. Two main systems are used — the TNM staging system and the number staging system (Stages 1–4) — alongside Gleason grading and PSA levels. Together, these determine which treatment options are most appropriate, as outlined in NICE guideline NG131.

TNM Staging System

The TNM system classifies cancer by Tumour size (T), lymph Node involvement (N), and Metastasis (M). Each element is given a number to represent how advanced the cancer is.

Tumour (T) — Size and Extent

T Stage	Description	Focal Therapy Suitability
T1	Tumour too small to be felt on digital rectal examination (DRE) or seen on standard imaging. Often found incidentally.	Potentially suitable — assessment required
T2a	Tumour in half of one lobe of the prostate or less.	Often suitable for focal therapy
T2b	Tumour in more than half of one lobe, but not both.	May be suitable — individual assessment
T2c	Tumour in both lobes of the prostate.	May be suitable — individual assessment
T3a	Tumour has grown through the prostate capsule on one or both sides.	Focal therapy less likely — other options preferred
T3b	Tumour has grown into the seminal vesicles.	Not typically suitable for focal therapy
T4	Tumour has spread to nearby organs (bladder, rectum, or pelvic wall).	Not suitable for focal therapy

Focal therapy suitability depends on multiple factors including tumour grade, PSA, and MRI findings. At The Focal Therapy Clinic, our consultants assess each patient individually using mpMRI and targeted biopsy results.

Nodes (N) — Lymph Node Involvement

N0 — the cancer has not spread to any nearby lymph nodes
N1 — the cancer has spread to nearby lymph nodes in the pelvis

Metastasis (M) — Distant Spread

M0 — the cancer has not spread to distant sites
M1a — spread to lymph nodes beyond the pelvis
M1b — spread to bones
M1c — spread to other organs (e.g. liver, lungs)

Number Staging System (Stages 1–4)

The number staging system groups prostate cancer into four stages based on tumour size, lymph node involvement, distant spread, Gleason grade, and PSA level. It is used alongside the TNM system to guide treatment decisions.

Stage	What It Means	Treatment Options	Five-Year Survival
Stage 1	Cancer confined within the prostate; small, low grade (Grade Group 1), PSA below 10. Often found via PSA testing. Most men have no symptoms.	Active surveillance, focal therapy (HIFU or NanoKnife), surgery, radiotherapy	Near 100% (Cancer Research UK)
Stage 2	Cancer still confined to the prostate but may be larger or involve more of the gland (T2b–T2c). PSA may be 10–20. Few or no symptoms.	Active surveillance, focal therapy, surgery, radiotherapy, radiotherapy plus hormone therapy	Near 100% (Cancer Research UK)
Stage 3	Cancer has grown beyond the prostate capsule or into the seminal vesicles (T3). Lymph nodes typically unaffected. Some men notice urinary symptoms.	Surgery (often with lymph node dissection), radiotherapy plus hormone therapy. Focal therapy less commonly recommended.	Approximately 95% (Cancer Research UK)
Stage 4	Cancer has spread to nearby lymph nodes (IVA) or distant sites such as bones or organs (IVB). Symptoms may include bone pain and fatigue.	Hormone therapy, chemotherapy, targeted therapy, radiotherapy, palliative care	Varies significantly by extent of spread

Source: staging definitions based on AJCC 8th edition; survival figures from Cancer Research UK.

Focal Therapy for Stage 1 and Stage 2 Prostate Cancer

For men diagnosed with localised prostate cancer (Stage 1 or Stage 2), focal therapy treats only the cancerous tissue within the prostate, preserving the surrounding healthy structures. At The Focal Therapy Clinic, our consultants offer two NICE-approved focal therapy options:

HIFU (High-Intensity Focused Ultrasound) — approved under NICE IPG424, uses focused ultrasound energy to destroy the tumour
NanoKnife IRE (Irreversible Electroporation) — approved under NICE IPG768, uses electrical pulses to destroy cancer cells while preserving surrounding tissue structures

In our clinic’s experience treating over 2,000 patients, focal therapy achieves 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265). Most patients return home the same day and 85% are back to work within two weeks.

“Not every patient is suitable for focal therapy, and we’re transparent about that. We assess every referral carefully with mpMRI and targeted biopsy before recommending treatment.”

— Mr Tim Dudderidge Consultant Urological Surgeon (FRCS(Urol), GMC: 4505451)

What Does the Gleason Score Mean?

The Gleason score indicates how aggressive prostate cancer cells appear under a microscope, and it plays a key role in determining which treatments are most appropriate. Lower Gleason scores (6) indicate slow-growing cancer that may be suitable for active surveillance or focal therapy, while higher scores (8–10) indicate more aggressive disease that typically requires radical treatment.

Gleason Score and Grade Groups

Pathologists grade two areas of the tumour on a scale from 3 to 5 and add them together to give the Gleason score. A newer system — the Grade Group — simplifies this into five categories:

Grade Group	Gleason Score	What It Means	Typical Treatment Options
Grade Group 1	6 (3+3)	Low grade — cells look close to normal; slow-growing	Active surveillance, focal therapy
Grade Group 2	7 (3+4)	Intermediate — predominantly well-formed glands with some poorly formed	Focal therapy, surgery, radiotherapy
Grade Group 3	7 (4+3)	Intermediate — predominantly poorly formed glands	Surgery, radiotherapy ± hormone therapy; focal therapy in selected cases
Grade Group 4	8	High grade — few recognisable glands	Surgery, radiotherapy plus hormone therapy
Grade Group 5	9–10	Very high grade — very aggressive disease	Multimodal treatment (surgery, radiotherapy, hormone therapy, chemotherapy)

At The Focal Therapy Clinic, men with Grade Group 1 or 2 prostate cancer confined to the prostate are often good candidates for focal therapy. In our audit of 265 patients treated with focal therapy, 90% remained cancer-free at one year, with 97% maintaining full urinary continence and 90%+ preserving sexual function.

What Are the Cambridge Prognostic Groups (CPGs)?

In the UK, clinicians commonly use Cambridge Prognostic Groups (CPGs) to classify prostate cancer risk. CPGs combine the tumour stage, Gleason grade, and PSA level into a single risk category that guides treatment recommendations, as outlined in NICE guideline NG131.

CPG	Risk Level	Typical Profile	Treatment Options
CPG 1	Low	Gleason 6 (Grade Group 1), PSA below 10, T1–T2a	Active surveillance, focal therapy (HIFU/NanoKnife)
CPG 2	Favourable intermediate	Gleason 3+4 (Grade Group 2), PSA 10–20, T1–T2b	Focal therapy, surgery, radiotherapy, active surveillance
CPG 3	Unfavourable intermediate	Gleason 4+3 (Grade Group 3), higher PSA	Surgery, radiotherapy ± hormone therapy; focal therapy in selected cases
CPG 4	High	Gleason 8 (Grade Group 4) or T3	Surgery plus radiotherapy, radiotherapy plus hormone therapy
CPG 5	Very high	Gleason 9–10 (Grade Group 5) or T4	Multimodal treatment (surgery, radiotherapy, hormone therapy, chemotherapy)

Men in CPG 1 and CPG 2 are often strong candidates for focal therapy at The Focal Therapy Clinic. Our medical suitability assessment includes detailed mpMRI review and targeted biopsy to confirm whether focal therapy is appropriate for your specific situation.

Frequently Asked Questions

What are the 4 stages of prostate cancer?

Prostate cancer is staged from 1 to 4 using the TNM system alongside Gleason grading and PSA levels. Stage 1 is the earliest — the cancer is small, low grade, and confined within the prostate. Stage 2 means the cancer is still organ-confined but may be larger. Stage 3 indicates the cancer has grown beyond the prostate capsule. Stage 4 means the cancer has spread to lymph nodes or distant sites such as bones. The vast majority of men are diagnosed at Stage 1 or 2, when the cancer is highly treatable with options including active surveillance, focal therapy, surgery, or radiotherapy.

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What are the symptoms of stage 2 prostate cancer?

Most men with Stage 2 prostate cancer have no noticeable symptoms. The cancer is still contained within the prostate gland and is typically detected through PSA testing or MRI rather than symptoms. Some men may experience urinary changes such as a weak stream or increased frequency, although these symptoms are much more commonly caused by benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.

What is the life expectancy of a person with prostate cancer?

Life expectancy depends on the stage and grade of the cancer, the man’s age and overall health, and the treatment received. For early-stage prostate cancer (Stage 1 and 2), the five-year survival rate is near 100% according to Cancer Research UK. Even Stage 3 prostate cancer has an approximately 95% five-year survival rate. For men with localised disease treated with focal therapy at The Focal Therapy Clinic, our audit of 265 patients shows 90% remain cancer-free at one year.

What is the prognosis of stage 4 prostate cancer?

The prognosis for Stage 4 prostate cancer varies significantly depending on the extent of spread and response to treatment. Stage 4A (spread to nearby lymph nodes only) generally has a better outlook than Stage 4B (distant spread to bones or organs). Modern treatments — including hormone therapy, chemotherapy, targeted therapies, and radiotherapy — mean that many men live for years with advanced prostate cancer. Your oncologist will discuss the most appropriate treatment plan based on your specific circumstances.