Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 7 of 11 in Prostate Cancer: Diagnosis and Management
Staging Prostate Cancer: TNM Classification and PSMA PET Scans
September 6, 2026
Before deciding on treatment, Dr. Amit Goel stages every prostate cancer patient using multiparametric MRI, which gives a fairly reliable read on whether cancer is present even ahead of biopsy confirmation, and a PSMA PET scan or bone scan, done specifically to check for distant spread before finalising the treatment plan.
T, N and M Staging
T-stage describes the tumour's local extent: T1 is non-palpable disease, picked up either after a TURP procedure (T1A) or because of an elevated PSA alone (T1C); T2 is a palpable tumour, confined to one lobe (T2A) or both (T2B); T3 means the disease has breached the prostate capsule; and T4 means local invasion into the bladder neck, external sphincter or rectum. N-stage is binary: N0 means no nearby lymph nodes are involved, N1 means regional lymph node enlargement is present. M-stage covers distant spread: M0 is no distant spread, M1A is spread to distant lymph nodes, M1B is spread to bone, and M1C is spread to other distant organs.
Why PSMA PET Has Become the Preferred Scan
PSMA PET uses a tracer specific to the prostate-specific membrane antigen, which makes it considerably more specific to prostate cancer than a conventional bone scan. Dr. Goel uses it as his final staging step before deciding on a treatment path, since it reliably picks up distant metastasis that a biopsy or MRI alone would miss.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Dr. Navala Gabriel
What is the average cost of robotic surgery for prostate cancer?
Dr. Amit Goel
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
Frequently Asked Questions
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
What is the difference between T1 and T2 prostate cancer?▼
T1 is a non-palpable tumour, often found only because of an elevated PSA. T2 is a palpable tumour, confined to one lobe of the prostate (T2A) or both lobes (T2B).
Why is a PSMA PET scan used for prostate cancer?▼
PSMA PET uses a tracer specific to the prostate-specific membrane antigen, making it more specific than a conventional bone scan for detecting whether prostate cancer has spread beyond the prostate.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer