Prostate cancer staging

Steven C. Campbell, M.D., Ph.D.

Prostate cancer Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Prostate Cancer from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Staging
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Biopsy
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Alternative Therapy
Case Studies
Case #1
Prostate cancer staging On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Prostate cancer staging All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Prostate cancer staging
CDC on Prostate cancer staging
Prostate cancer staging in the news
Blogs on Prostate cancer staging
Directions to Hospitals Treating Prostate cancer
Risk calculators and risk factors for Prostate cancer staging

Overview

Prostate cancer may be classified into several subtypes based on TNM system and UICC.

TNM staging

Evaluation of the (primary) tumor ('T')

• TX: cannot evaluate the primary tumor
• T0: no evidence of tumor
• T1: tumor present, but not detectable clinically or with imaging
  • T1a: tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons)
  • T1b: tumor was incidentally found in greater than 5% of prostate tissue resected
  • T1c: tumor was found in a needle biopsy performed due to an elevated serum PSA
• T2: the tumor can be felt (palpated) on examination, but has not spread outside the prostate
  • T2a: the tumor is in half or less than half of one of the prostate gland's two lobes
  • T2b: the tumor is in more than half of one lobe, but not both
  • T2c: the tumor is in both lobes
• T3: the tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2)
  • T3a: the tumor has spread through the capsule on one or both sides
  • T3b: the tumor has invaded one or both seminal vesicles
• T4: the tumor has invaded other nearby structures

It should be stressed that the designation "T2c" implies a tumor which is palpable in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but which are not palpable bilaterally should not be staged as T2c.

Evaluation of the regional lymph nodes ('N')

• NX: cannot evaluate the regional lymph nodes
• N0: there has been no spread to the regional lymph nodes
• N1: there has been spread to the regional lymph nodes

Evaluation of distant metastasis ('M')

• MX: cannot evaluate distant metastasis
• M0: there is no distant metastasis
• M1: there is distant metastasis
  • M1a: the cancer has spread to lymph nodes beyond the regional ones
  • M1b: the cancer has spread to bone
  • M1c: the cancer has spread to other sites (regardless of bone involvement)

UICC staging

The UICC further groups the TNM data into the stages listed in the table below:

• Stage I

T	N	M	Definition
T1, T2a	N0	M0	Tumour involves half a lobe or less

• Stage II

T	N	M	Definition
T2b, T2c	N0	M0	Tumour involves more than half a lobe but is limited to the prostate

• Stage III

T	N	M	Definition
T3	N0	M0	Tumour has spread beyond the prostatic capsule or into the bladder neck or seminal vesicles

• Stage IV

T	N	M	Definition
T4	N0	M0	Tumour has become fixed to adjoining structures like the rectum or pelvic wall
any T	N1	M0	Tumour has spread to regional lymph nodes
any T	any N	M1	Tumour has spread to distant sites such as lungs or liver