Prostate cancer staging

Prostate cancer staging can be thought of in terms of physical location or grading histologically. The TNM classification is used to determine spread and the Gleason score is used to determine histological type. Another staging system is the Jewett-Whitmore staging system.

Additionally there is some overlap with pre-biopsy imaging assessment using Prostate imaging-reporting and data system (PIRADS).

TNM staging
Primary tumour staging (T)
  • T1: not palpable via DRE or seen using TRUS
    • T1a: cancer found incidentally during TURP, less than 5% of the gland
    • T1b: cancer found incidentally but over 5% of the gland is involved
    • T1c: found by needle biopsy for a raised PSA
  • T2: palpable on DRE, but confined to the prostate
    • T2a: less than half of one lobe
    • T2b: more than half of one lobe
    • T2c: cancer in both lobes of the prostate
  • T3: spread outside the prostate
    • T3a: extracapsular extension (one or both sides)
    • T3b: tumour invades the seminal vesicles
  • T4: spread into the adjacent tissues (other than seminal vesicles)
Nodal status (N)

On CT a 1 cm short axis diameter cut off is used if its purely on size grounds 1.

  • N0: no spread to lymph nodes
  • N1: one or more nearby lymph nodes involved
Metastases (M)
  • M0: no spread beyond regional lymph nodes
  • M1: spread beyond local nodes
    • M1a: distant lymph nodes outside the pelvic
    • M1b: bony metastasis
    • M1c: other organ involvement independant of bony involvement
      • e.g. lungs, liver, brain 
Histopathologic grading

Gleason scores can be then grouped into a variety of grades:

  • Gx: grade cannot be assessed
  • G1: well-differentiated (slight anaplasia) (Gleason score of 2-4)
  • G2: moderately differentiated (moderate anaplasia) (Gleason score of 5-6)
  • G3-4: poorly differentiated or undifferentiated (marked anaplasia) (Gleason score of 7-10)
Stage groupings
  • stage I
    • T1a, N0, M0, G1
  • stage II
    • T1a, N0, M0, G2-4
    • T1b, N0, M0, any G
    • T1c, N0, M0, any G
    • T1, N0, M0, any G
    • T2, N0, M0, any G
  • stage III
    • T3, N0, M0, any G
  • stage IV
    • T4, N0, M0, any G
    • any T, N1, M0, any G
    • any T, any N, M1, any G

See also

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