Revision 27 for 'Prostate cancer (staging)'All Revisions
Prostate cancer staging
Prostate cancer staging can be thought of in terms of physical location or grading histologically. The TNM classification is used to determine spread and the Gleason score is used to determine histological type. Another staging system is the Jewett-Whitmore staging system.
Additionally there is some overlap with pre-biopsy imaging assessment using Prostate imaging-reporting and data system (PIRADS).
Primary tumor staging (T)
- T1 - not palpable via DRE or seen using TRUS
T2 - palpable on DRE, but confined to the prostate
- T2a - less than half of one side of the gland
- T2b - more than half of one side
- T2c - cancer on both sides of the prostate
T3 - spread outside the prostate
- T3a - tumor has extended outside of the prostate on one side.
T3b - tumor has extended outside of the prostate on both sides.
T3c - tumor has invaded one or both of the seminal vesicles, which are small bag-like organs near the bladder
- T4 - spread into the adjacent tissues
Nodal status (N)
On CT a 1 cm short axis diameter cut off is used if its purely on size grounds 7.
- N0 - no spread to lymph nodes
- N1 - one or more nearby lymph nodes involved
- M0 - no spread beyond regional lymph nodes
M1 - spread beyond local nodes
- M1a - distant lymph nodes outside the pelvic
- M1b - bony metastasis
M1c - other organ involvement independant of bony involvement
- e.g. lungs, liver, brain
Gleason scores can be then grouped into a variety of grades:
- Gx - grade cannot be assessed
- G1 - well-differentiated (slight anaplasia) (Gleason score of 2-4)
- G2 - moderately differentiated (moderate anaplasia) (Gleason score of 5-6)
- G3-4 - poorly differentiated or undifferentiated (marked anaplasia) (Gleason score of 7-10)
- T1a, N0, M0, G1
- T1a, N0, M0, G2-4
- T1b, N0, M0, any G
- T1c, N0, M0, any G
- T1, N0, M0, any G
- T2, N0, M0, any G
- T3, N0, M0, any G
- T4, N0, M0, any G
- any T, N1, M0, any G
- any T, any N, M1, any G