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Cancer Staging Systems

Staging of Prostate cancer

Last Update: Saturday October 18th, 2008.

TNM definition

Primary tumor (T)

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • T1: Clinically inapparent tumor not palpable nor visible by imaging
    • T1a: Tumor incidental histologic finding in 5% 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 5-6)
  • G3-4: Poorly differentiated or undifferentiated (marked anaplasia) (Gleason 7-10)

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.

Stage grouping

Memory Aid:
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.

Stage I

  • T1a, N0, M0, G1

Stage II

  • 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

Stage III

  • T3, N0, M0, any G

Stage IV

  • T4, N0, M0, any G
  • Any T, N1, M0, any G
  • Any T, any N, M1, any G


  1. Prostate. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 309-316.

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