Prostate
Miscellaneous
Staging

Authors: Komal Arora, M.D. (see Authors page)

Revised: 2 September 2016, last major update July 2012

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: prostatic staging[title]

Cite this page: Staging. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostatestaging.html. Accessed December 3rd, 2016.
Definition / General
References: Edge: AJCC Cancer Staging Manual, 7th edition, 2010, staging forms, National Cancer Institute (US)

Primary tumor (T) - Clinical staging
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • T1: Clinically inapparent tumor neither palpable nor visible by imaging
  • 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 (e.g. because of elevated PSA)
  • T2: Tumor confined within prostate
  • T2a: Tumor involves one half of one lobe or less
  • T2b: Tumor involves more than one half of one lobe, but not both lobes
  • T2c: Tumor involves both lobes
  • T3: Tumor extends through the prostatic capsule
  • T3a: Extracapsular extension (unilateral or bilateral)
  • T3b: Tumor invades seminal vesicle(s)
  • T4: Tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles or pelvic wall

  • Notes:
    • Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c
    • Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified as T2, not T3


Primary tumor (T) - Pathologic staging
  • pT2: Organ confined
  • pT2a: Unilateral, one half of one side or less
  • pT2b: Unilateral, involving more than one half of one side, but not both sides
  • pT2c: Bilateral disease
  • pT3: Extraprostatic extension
  • pT3a: Extraprostatic extension or microscopic invasion of bladder neck
  • pT3b: Seminal vesicle invasion
  • pT4: Invasion of rectum, levator muscles or pelvic wall

  • Notes:
    • Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c
    • Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified as T2, not T3
    • There is no pathologic T1 classification
    • Value of T2 substaging has been questioned (J Urol 2011;186:790)
    • Margins are important, and margin status is independent of T classification; classify positive margins as either focal or extensive based on the length of involvement of the inked line of resection
    • Laterality of extraprostatic extension (EPE) is not prognostically important
    • EPE should be quantitated as focal (< 1 HPF on 1-2 sections) or nonfocal
    • Determine EPE in radical prostatectomy specimens by comparing the presence of tumor to the normal edge of the prostate gland
    • Seminal vesicle invasion means tumor invades its muscular coat, seen first at the base of the seminal vesicles
    • The amount of tumor in the seminal vesicles is not important
    • pT3 can have positive or negative margins
    • Patients with clinical T3 disease are usually not surgical candidates - 50% have nodal metastases at diagnosis, 50% develop metastases at 5 years and 75% die of prostate carcinoma within 10 years
    • Margins: apex is most frequent site of positive margin; positive margins at base usually indicate extensive disease; tumor at anterior region margin usually is considered extraprostatic extension because usually is exterior to prostate; Close margins (< 1 mm) are considered adequate for prostate


Regional lymph nodes (N)
  • NX: Regional lymph nodes were not assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis in regional lymph node(s)

  • Notes:
    • pNX, pN0 and pN1 are the same as cNX, cN0 and cN1
    • NX, N0, N1 may lack clinical relevance; Some surgeons proceed with radical prostatectomy even if nodes are positive at frozen section if preoperative Gleason score is 7 or less, since time to onset of distant metastases is long
    • Metastases to periprostatic or periseminal vesicle lymph nodes suggests poor prognosis (Am J Surg Pathol 2001;25:1429)


Distant metastases
  • M0: No distant metastasis
  • M1: Distant metastasis
  • M1a: Distant metastasis to non-regional lymph node(s)
  • M1b: Distant metastasis to bone(s)
  • M1c: Distant metastasis to other site(s) with or without bone disease

  • Notes:
    • When more than one site of metastasis is present, the most advanced category is used
    • pM1c is most advanced


Anatomic stage / Prognostic groups
  • Stage I: T1a-2a N0 M0 PSA < 10 Gleason 6 or less OR T1-2a N0 M0 PSA unknown Gleason unknown
  • Stage IIA: T1a-c N0 M0 PSA < 20 Gleason 7 OR T1a-c N0 M0 PSA 10-19.9 Gleason 6 or less OR T2a-b N0 M0 PSA < 20 Gleason 7 or less OR T2b N0 M0 PSA unknown Gleason unknown
  • Stage IIB: T2c N0 M0 Any PSA Any Gleason OR T1-2 N0 M0 PSA 20 or higher Any Gleason OR T1-2 N0 M0 Any PSA Gleason 8 or higher
  • Stage III: T3a-b N0 M0 Any PSA Any Gleason score
  • Stage IV: T4 or N1 or M1

  • Notes:
    • When either PSA or Gleason is not available, grouping should be determined by T stage or either PSA or Gleason as available
    • Partin tables: Nomograms predicting pathologic stage based on TNM clinical stage, PSA and Gleason score (Johns Hopkins, J Urol 1993;150:110)
    • Close relationship between pathologist and urologist is essential (European Urology Supplements 2008;7:1)
Diagrams / Tables
Images hosted on other servers:

Micro Images
Images hosted on other servers:

Extraprostatic extension

Radical prostatectomy with periprostatic fat
tissue invasion (pT3a): left - direct invasion,
right - invasion through neurovascular bundle

Radical prostatectomy with periprostatic fat tissue
invasion (pT3a): adenocarcinoma is outside the
edge of the extraprostatic area (discontinuous line)
at the level of periprostatic fat tissue (arrows)