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Grading & Staging Systems |
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Gleason Grade
- This is a system based on the degree of glandular differentiation and growth pattern. Five patterns have been described.
- A Gleason "score" is given for each tumor, representing the sum of the two most common patterns displayed. The scores range from 2 to 10 and have some prognostic predictive value at the very low or very high ranges.
- This is the most commonly used grading system for prostate adenocarcinoma
| Table 1. Prostate Cancer TNM Clinical Staging System AJCC 20021 |
| TX |
Primary tumor cannot be assessed |
| T1 |
Clinically inapparent tumor neither palpable or visible by imaging |
| T1a |
Normal DRE; incidental tumor ≤ 5% of total surgical specimen and of low to medium grade |
| T1b |
Normal DRE: incidental tumor > 5% of specimen, any grade, or < 5% of specimen with any high grade |
| T1c |
Normal DRE; tumor identified by prostate needle biopsy (e.g. elevated PSA) |
| T2 |
Tumor confined to the prostate |
| T2a |
Organ-confined limited to half of one lobe of the prostate or less |
| T2b |
Organ-confined; more than one half of a lobe but not both |
| T2c |
Tumor involves both lobes |
| T3 |
Tumor extends through the prostate 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 (e.g., bladder, rectum) |
| Regional Lymph Nodes (N) |
| NX |
Regional lymph nodes cannot be assessed |
| N0 |
No regional lymph node metastasis |
| N1 |
Metastasis in regional lymph node or nodes |
| Distant Metastasis (M) |
| MX |
Distant metastasis cannot be assessed |
| M0 |
No distant metastasis |
| M1a |
Nonregional lymph node metastasis |
| M1b |
Bone metastasis |
| M1c |
Other metastatic sites with or without bone disease |
| Grade |
| G1 |
Well differentiated (Gleason score 2 -4) |
| G2 |
Moderately differentiated (Gleason score 5-6) |
| G3-4 |
Poorly differentiated or undifferentiated (marked anaplasia) (Gleason score 7-10) |
| Clinical Stage Grouping2 |
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G1 |
G2-4 |
Any Grade |
| |
T1a |
T1bc |
T2 |
T3 |
T4 |
| N0 |
I |
II |
II |
II |
III |
IV |
| N1 |
IV |
IV |
IV |
IV |
IV |
IV |
| M1 |
IV |
IV |
IV |
IV |
IV |
IV |
| Pathologic Stage |
| pT2 |
Tumor confined to the prostate* |
| T2a |
Unilateral, involving one half of one lobe or less |
| T2b |
Unilateral, more than one half of a lobe but not both |
| T2c |
Tumor involves both lobes |
| T3 |
Extraprostatic extension** |
| T3a |
Extracapsular extension (unilateral or bilateral) |
| T3b |
Seminal vesicle invasion |
| T4 |
Invasion of bladder or rectum |
*there is no pathologic T1 description
**positive margin of resection denoted by an R1 descriptor
References
- American Joint Committee on Cancer (2002). Prostate. In AJCC Cancer Staging Manual, 6th ed., pp. 309-316. New York: Springer-Verlag.
- Lin EH, Lozano R and Karp DD. Color-Matrix Cancer Staging and Treatment Handbook, 3rd edition. The University of Texas MD Anderson Cancer Center, 2004, p. 28.
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Prostate Cancer 
