Prostate cancer staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Steven C. Campbell, M.D., Ph.D. Syed Musadiq Ali M.B.B.S.[2]

Overview

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

Evaluation of the (primary) tumor (‘T’)^[1]


T	Definition

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	Tumor can be felt (palpated) on examination, but has not spread outside the prostate
T2a	Tumor is in half or less than half of one of the prostate gland’s two lobes
T2b	Tumor is in more than half of one lobe, but not both
T2c	Tumor is in both lobes
T3	Tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2)
T3a	Tumor has spread through the capsule on one or both sides
T3b	Tumor has invaded one or both seminal vesicles
T4	Tumor has invaded other nearby structures

Evaluation of the regional lymph nodes (‘N’)


N	Definition

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’)


M	Definition

M0	There is no distant metastasis
M1	There is distant metastasis

The UICC further groups the TNM data into the stages listed in the table below:^[2]


T	N	M	Definition

T1, T2a	N0	M0	Tumor involves half a lobe or less


T	N	M	Definition

T2b, T2c	N0	M0	Tumor involves more than half a lobe but is limited to the prostate


T	N	M	Definition

T3	N0	M0	Tumor has spread beyond the prostatic capsule or into the bladder neck or seminal vesicles


T	N	M	Definition

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