Stage of prostate cancer

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This means how advanced the cancer has become at that moment in time. It categorises patients into clearly defined groups, each one having its own prognosis and optimal treatment strategy. The most widely used staging system is TNM but others including the Whitmore-Jewett System is popular in the USA:-

TNM Classification of Prostate Cancer (Modified from Schröder. Et al, 1992)

TO - No evidence of primary tumour

T1 Clinically unapparent tumour, impalpable and not visible by imaging
T1a Tumour an incidental finding in <5% of resected tissue
T1b Tumour an incidental finding in > 5% of resected tissue
T1c Tumour identified by needle biopsy (eg because of raised PSA)

T2 Tumour confined within prostate
T2a Tumour involves < half a lobe
T2b Tumour involves > half a lobe but not both lobes
T2c Tumour involves both lobes

T3 Tumour extends through the prostate capsule
T3a Unilateral extracapsular extension
T3b Bilateral extracapsular extension
T3c Tumour invades seminal vesicles

T4 Tumour is fixed or invades adjacent structures
T4a Tumour invasion of bladder neck, external sphincter or rectum
T4b Tumour invasion of levator muscles or fixed to pelvic side wall


Regional Lymph Nodes
N0 No regional lymph node metastases
N1 Metastasis in a single regional lymph node, <2cm in greatest dimensions
N2 Metastasis in a single regional lymph node, 2cm-<5cm in greatest dimension, ormultiple regional lymph nodes, <5cm in greatest dimension
N3 Metastasis in a single regional lymph node, >5cm in greatest dimension

Distant Metastases
M0 No distant metastasis
M1 Distant metastasis
M1a Non-regional lymph node(s)
M1b Bone(s)
M1c Other site(s)

Whitmore-Jewett Staging System

A1 Microscopic focus of well-differentiated adenocarcinoma in up to three foci of transurethral specimens or enucleation; clinically not apparent on rectal examination

A2 Tumour not well differentiated or present in more than 3 areas

B1 Asymptomatic palpable nodule <1.5cm; normal surrounding prostate; no capsular extension; normal acid phosphatase

B2 Diffuse involvement of gland; no capsular extension; normal acid phosphatase

C Extension local tumour with penetration through the capsule; contiguous spread may involve seminal vesicles, bladder neck, lateral side wall of pelvis; acid phosphatase may be elevated; normal bone scan

D1 Metastases to pelvic lymph nodes below aortic bifurcation; acid phosphatase may be elevated

D2 Bone or lymph node metastases above aortic bifurcation or other soft tissue metastases

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