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Cancer Staging Systems
Staging of Prostate cancer
Last Update: Saturday October 18th, 2008.
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- T1: Clinically inapparent tumor not palpable nor visible
- T1a: Tumor incidental histologic finding in
or less of tissue resected (in prostatectomy)
- T1b: Tumor incidental histologic finding in more than
5% of tissue resected
- T1c: Tumor identified by needle biopsy (e.g., because
of elevated PSA)
- T2: Tumor confined within prostate*
- T2a: Tumor involves one-half of 1 lobe or less
- T2b: Tumor involves more than one-half of 1 lobe but
not both lobes
- T2c: Tumor involves both lobes
- T3: Tumor extends through the prostate capsule**
- T3a: Extracapsular extension (unilateral or bilateral)
- T3b: Tumor invades seminal vesicle(s)
- T4: Tumor is fixed or invades adjacent structures other
than seminal vesicles: bladder neck, external sphincter, rectum, levator
muscles,and/or pelvic wall
٭ Note: Tumor found in one or both lobes by needle biopsy. But not
palpable or reliably visible by imagine, is classified as T1c.
٭٭ Note: Invasion of the prostate apex or into (but not beyond) the
prostatic capsule is not classified as T3, but as T2.
Regional lymph nodes (N)
- NX: Regional lymph nodes were not assessed
- N0: No regional lymph node metastasis (lymph nodes confined
to the true pelvis)
- N1: Metastasis in regional lymph node(s)
Distant metastasis (M)*
- MX: Distant metastasis cannot be assessed (not evaluated
by any modality)
- M0: No distant metastasis
- M1: Distant metastasis
- M1a: Nonregional lymph node(s)
- M1b: Bone(s)
- M1c: Other site(s) with or without bone disease
٭ Note: When more than one site of metastasis is present, the most
advanced category is used. PMIc is most advanced.
Histopathologic grade (G)
- GX: Grade cannot be assessed
- G1: Well differentiated (slight anaplasia) (Gleason 2-4)
- G2: Moderately differentiated (moderate anaplasia) (Gleason
- G3-4: Poorly differentiated or undifferentiated (marked
Gleason score: In general, degree of tumor differentiation and abnormality
of histologic growth pattern directly correlate with likelihood of metastases
and with death. Because of marked variability in tumor differentiation from
one microscopic field to another, many pathologists will report the range
of differentiation among the malignant cells that are present in a biopsy,
also known as Gleason score.
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Stage I corresponds to T1a, G1 only.
Stage II corresponds to T2 plus any the remaining T1 subclasses (T1b, T1c)
Stage III corresponds to T3
Stage IV corresponds to T4 or N, or M.
- T1a, N0, M0, G2, 3-4
- T1b, N0, M0, any G
- T1c, N0, M0, any G
- T1, N0, M0, any G
- T2, N0, M0, any G
- T4, N0, M0, any G
- Any T, N1, M0, any G
- Any T, any N, M1, any G
- Prostate. In: American Joint Committee on Cancer.: AJCC Cancer
Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 309-316.