Prostate cancer (staging)

Changed by Daniel J Bell, 30 Apr 2019

Updates to Article Attributes

Body was changed:

Prostate cancer staging takes into account TNM (primary site, nodal and distant metastases), pretreatment PSA and histological grading. The Gleason score is used to determine the Grade Group. 

Another, less used, staging system is the Jewett-Whitmore staging system.

Additionally, there is some overlap with pre-biopsyprebiopsy imaging assessment using Prostate imaging-reportingImaging-Reporting and data system (PIRADSData System (PI-RADS).

TNM staging
Clinical primary tumour staging (cT)
  • TX: primary tumour cannot be assessed
  • T0: no evidence of primary tumour
  • T1: clinically inapparent tumor that is not palpable
    • T1a: tumor incidental histologic finding in 5% or less of tissue resected
    • T1b: tumor incidental histologic finding in more than 5% of tissue resected
    • T1c: tumor identified by needle biopsy found in one or both sides, but not palpable
  • T2: tumor is palpable and confined within prostate
    • T2a: tumor involves one-half of one side or less
    • T2b: tumor involves more than one-half of one side but not both sides
    • T2c: tumor involves both sides
  • T3: extraprostatic tumor that is not fixed or does not invade adjacent structures
  • T4: tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
Pathological primary tumour staging (pT)
  • T2: organ confined
  • T3: extraprostatic extension
    • T3a: extraprostatic extension (unilateral or bilateral) or microscopic invasion of bladder neck
    • T3b: tumour invades seminal vesicle(s)
  • T4: tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
Regional nodal status (N)

Regional lymph nodes are defined as those of the true pelvis (ie(i.e. pelvic nodes below the bifurcation of the common iliac arteries).

Nodal status is based on PSMA PET/CT, MRI or CT.  On CTMRI/CT a 1 cm short axis diameter cut off is used if its purely on size groundsis the sole criterion for adenopathy 1.

  • NX: regional nodes were not assessed
  • N0: no positive regional nodes
  • N1: metastases in regional node(s)
Distant Metastasis (M)
  • M0: no distant metastasis
  • M1: distant metastasis
    • M1a: nonregionalnon-regional lymph node(s)
      • note that a node along the common iliac arteries would be considered M1a, not N1
    • M1b: bone(s)
    • M1c: other site(s) with or without bone disease
      • e.g. lungs, liver, brain
Histologic grading

Gleason scores are compressed into Grade Groups (table 2) 8.

Stage groupings

Prognostic stage groupings (table 1) are determined by TNM, pretreatment serum PSA and histologic Grade Groups 7

  • -<p><strong>Prostate cancer staging</strong> takes into account <a href="/articles/tnm-staging-system">TNM</a> (primary site, nodal and distant metastases), pretreatment PSA and histological grading. The <a href="/articles/gleason-score-and-grade-group">Gleason score</a> is used to determine the Grade Group. </p><p>Another, less used, staging system is the <a href="/articles/jewett-whitmore-staging-system">Jewett-Whitmore staging system</a>.</p><p>Additionally, there is some overlap with pre-biopsy imaging assessment using <a href="/articles/prostate-imaging-reporting-and-data-system-1">Prostate imaging-reporting and data system (PIRADS)</a>.</p><h5>TNM staging</h5><h6>Clinical primary tumour staging (cT)</h6><ul>
  • +<p><strong>Prostate cancer staging</strong> takes into account <a href="/articles/tnm-staging-system">TNM</a> (primary site, nodal and distant metastases), pretreatment PSA and histological grading. The <a href="/articles/gleason-score-and-grade-group">Gleason score</a> is used to determine the Grade Group. </p><p>Another, less used, staging system is the <a href="/articles/jewett-whitmore-staging-system">Jewett-Whitmore staging system</a>.</p><p>Additionally, there is some overlap with prebiopsy imaging assessment using <a href="/articles/prostate-imaging-reporting-and-data-system-1">Prostate Imaging-Reporting and Data System (PI-RADS)</a>.</p><h5>TNM staging</h5><h6>Clinical primary tumour staging (cT)</h6><ul>
  • -<strong>T3a:</strong> <a title="Extraprostatic extension of prostate cancer" href="/articles/extraprostatic-extension-of-prostate-cancer">extraprostatic extension</a> (unilateral or bilateral)</li>
  • +<strong>T3a:</strong> <a href="/articles/extraprostatic-extension-of-prostate-cancer">extraprostatic extension</a> (unilateral or bilateral)</li>
  • -</ul><h6>Regional nodal status (N)</h6><p>Regional lymph nodes are defined as those of the true pelvis (ie. pelvic nodes below the bifurcation of the common iliac arteries).</p><p>Nodal status is based on <a href="/articles/prostate-specific-membrane-antigen">PSMA</a> PET/CT, MRI or CT.  On CT a 1 cm short axis diameter cut off is used if its purely on size grounds <sup>1</sup>.</p><ul>
  • +</ul><h6>Regional nodal status (N)</h6><p>Regional lymph nodes are defined as those of the true pelvis (i.e. pelvic nodes below the bifurcation of the common iliac arteries).</p><p>Nodal status is based on <a href="/articles/prostate-specific-membrane-antigen">PSMA</a> PET/CT, MRI or CT.  On MRI/CT a 1 cm short axis diameter cut off is used if size is the sole criterion for adenopathy <sup>1</sup>.</p><ul>
  • -<strong>M1a:</strong> nonregional lymph node(s)<ul><li>note that a node along the common iliac arteries would be considered M1a, <em>not N1</em>
  • -</li></ul>
  • +<strong>M1a:</strong> non-regional lymph node(s)<ul><li>note that a node along the common iliac arteries would be considered M1a, not N1</li></ul>
  • -</ul><h5>Histologic grading</h5><p><a href="/articles/gleason-score">Gleason scores</a> are compressed into Grade Groups (table 2) <sup>8</sup>.</p><h5>Stage groupings</h5><p>Prognostic stage groupings (table 1) are determined by TNM, pretreatment serum PSA and histologic Grade Groups <sup>7</sup>. </p><p> </p>
  • +</ul><h5>Histologic grading</h5><p><a href="/articles/gleason-score-and-grade-group">Gleason scores</a> are compressed into Grade Groups (table 2) <sup>8</sup>.</p><h5>Stage groupings</h5><p>Prognostic stage groupings (table 1) are determined by TNM, pretreatment <a href="/articles/prostate-specific-antigen-1">serum PSA</a> and histologic Grade Groups <sup>7</sup>. </p>

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.