staging of prostate cancer

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Introduction

TNM staging for prostate cancer

T1a: incidentally detected tumor, < 5% of resected tissue

T1b: incidentally detected tumor, > 5% of resected tissue

T1c: impalpable tumor, detected by needle biopsy

T2a: tumor confined to prostate, < 50% of 1 lobe involved

T2b: tumor confined to prostate, > 50% of 1 lobe involved

T2c: tumor confined to prostate, both lobes involved

T3a: unilateral extension through prostate capsule

T3b: bilateral extension through prostate capsule

T3c: tumor invades seminal vesicles

T4a: tumor invades bladder neck, external sphincter, or rectum

T4b: tumor invades levator ani muscle &/or fixes to pelvic wall

N1: metastasis to lymph node, < 2 cm in diameter

N2: metastasis to lymph node, 2 < 5 cm in diameter

N3: metastasis to lymph node, > 5 cm in diameter

M1: distant metastases

ABCD staging for prostate cancer

A1(T1a): incidentally detected tumor, < 5% of resected tissue

A2(T1b): incidentally detected tumor, > 5% of resected tissue

T1c: impalpable tumor, detected by needle biopsy

B1(T2a): tumor confined to prostate, < 50% of 1 lobe involved

B2(T2b): tumor confined to prostate, > 50% of 1 lobe involved

B3(T2c): tumor confined to prostate, both lobes involved

C(T3): extracapsular local disease

D1: pelvic nodal involvement

D2: distant metastases

AJCC stage grouping for prostate cancer*

Stage 1: T1a, N0, M0, G1

Stage 2:

  • T1a, N0, M0, G2-4
  • T1b, N0, M0,any G
  • T1c, N0, M0, any G
  • T2, N0, M0, any G

Stage 3: T3, N0, M0, any G

Stage 4:

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

* G = Gleason score

Risk for recurrence based on initial staging

Risk stage Gleason score PSA
Low risk T1-T2a G=2-6 PSA <= 10 ug/L
Intermediate risk T2b,T2c G=7 PSA 10-20 ug/L
High risk T3a G=8-10 PSA >= 20 ug/L

More general terms

Additional terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 554-55
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 674-676