The clinical staging of prostate cancer uses pretreatment parameters to predict the extent of disease, for assessment of prognosis and to assist in decisions regarding appropriate treatment. Pretreatment information used to predict disease extent in men with prostate cancer include DRE (T stage), PSA and its derivatives, prostate cancer features on needle biopsy, and in recurrent disease radiologic imaging.
- Pathologic stage is determined after prostate removal and involves histologic analysis of the prostate, seminal vesicles, and pelvic lymph nodes if lymphadenectomy is performed.
- Pathologic staging more accurately estimates disease burden and is more useful than clinical staging for outcome prediction. The most important pathologic criteria that predict prognosis after radical prostatectomy are tumor grade, surgical margin status, extracapsular disease, seminal vesicle invasion, and pelvic lymph node involvement.
- Biochemical recurrence-free survival and cancer-specific survival are both inversely related to the pathologic stage of disease.
- 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
|Anatomic Stage / Prognostic Groups|
||T1a-c||NO||MO||PSA < 10||Gleason ≤ 6|
|T2a||NO||MO||PSA < 10||Gleason ≤ 6|
|T1-2a||NO||MO||PSA X||Gleason X|
|T1a-c||NO||MO||PSA≥10<20||Gleason ≤ 6|
|T2b||NO||MO||PSA X||Gleason X|
||T2c||NO||MO||Any PSA||Any Gleason|
|T1-2||NO||MO||PSA ≥ 20||Any Gleason|
|T1-2||NO||MO||Any PSA||Gleason ≥8|
|III||T3a-b||NO||MO||Any PSA||Any Gleason|
||T4||NO||MO||Any PSA||Any Gleason|
|Any T||N1||MO||Any PSA||Any Gleason|
|Any T||Any N||M1||Any PSA||Any Gleason|
|Prostate Cancer Primary Tumor [T] TNM Clinical Staging System AJCC 2010|
|TX||Primary tumor cannot be assessed|
|T0||No evidence of primary tumor|
|T1||Clinically inapparent tumor neither palpable nor visible by imaging|
|T1a||Normal DRE; incidental tumor ≤ 5% of total surgical specimen in histological finding|
|T1b||Normal DRE: incidental tumor > 5% of specimen, any grade, or < 5% of resected specimen|
|T1c||Normal DRE; tumor identified by prostate needle biopsy (e.g. elevated PSA)|
|T2||Tumor confined to the prostate |
|T2a||Organ-confined limited to one half of one lobe of the prostate or less|
|T2b||Organ-confined; more than one half of a lobe but not both lobes|
|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)|
 Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visiblle by imaging, is classified as T1c.
 Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified not as T3, but as T2.
 When more than one site of metastasis is present, the most advanced category is used. pM1c is most advanced.
 There is no pathologic T1 description
MOLECULAR STAGING OF PROSTATE CANCER
The recent regulatory approval of the semiautomated CellSearch system (Veridex, Raritan, NJ) for monitoring prostate cancer, has led to investigation to determine whether circulating tumor cells have a role in the staging of early disease.
American Joint Committee on Cancer (2010). Prostate. In AJCC Cancer Staging Manual, 7th ed. (Part IX. Genitourinary Sites - Prostate) Edge, S.B.; Byrd, D.R.; Compton, C.C.; Fritz, A.G.; Greene, F.L.; Trotti, A. (Eds.)
Davis et al, 2008. Davis JW, Nakanishi H, Kumar VS, et al: Circulating tumor cells in peripheral blood samples from patients with increased serum prostate specific antigen: initial results in early prostate cancer. J Urol 2008; 179(6):2187-2191.
Helo et al, 2009. Helo P, Cronin AM, Danila DC, et al: Circulating prostate tumor cells detected by reverse transcription-pcr in men with localized or castration-refractory prostate cancer: concordance with CellSearch assay and association with bone metastases and with survival. Clin Chem 2009; 55(4):765-773.
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.
Pound et al, 1997. Pound CR, Partin AW, Epstein JI, et al: Prostate-specific antigen after anatomic radical retropubic prostatectomy. Patterns of recurrence and cancer control. Urol Clin North Am 1997; 24(2):395-406.