Radiation Oncology/Prostate/Staging

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Prostate Cancer Staging

[edit] AJCC Staging

T-stage:

• T1a - incidental histologic finding in 5% or less of tissue resected
• T1b - incidental histologic finding in more than 5% of tissue resected
• T1c - identified by needle biopsy (e.g., because of elevated PSA)
• T2a - involves one half of one lobe or less
• T2b - involves more than one half of one lobe but not both lobes
• T2c - involves both lobes
• T3a - extracapsular extension (unilateral or bilateral)
• T3b - invades seminal vesicles
• T4 - fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

Pathologic staging: there is no pT1 classification

N-stage:

• N0 - none
• N1 - yes

Regional lymph nodes: pelvic, hypogastric, obturator, iliac (internal, external), sacral
Distant lymph nodes: aortic, common iliac, inguinal (deep), inguinal (superficial, femoral), supraclavicular, cervical, scalene, retroperitoneal

M-stage:

• M0 - none
• M1a - non-regional lymph nodes
• M1b - bone
• M1c - other sites

Overall stage:

• I - T1a N0 G1
• II - T1a G2-4, T1b-1c, T2
• III - T3 N0
• IV - T4, N1, M1

Grade: G1 - well differentiated (Gleason 2-4), G2 - moderately differentiated (Gleason 5-6), G3-4 - poorly differentiated (Gleason 7-10)

Older versions systems

• 1997 AJCC
  • T1 - same as 2002. T2a - < 1/2 lobe, T2b - > 1/2 lobe or both lobes. No T2c. T3a - unilateral ECE, T3b - bilateral ECE.
• 1992 AJCC
  • T1 and T2 - same as 2002. T3a - unilateral ECE, T3b - bilateral ECE, T3c - seminal vesicle involvement.

[edit] Jewett Whitmore Staging

• Historically used in the US, until AJCC become adopted

• Stage A - no palpable on DRE, no symptoms
  • A1: small tumor focus entirely within the gland
  • A2: diffuse involvement of gland
• Stage B - palpable, but contained within capsule
  • B1: <1.5 cm in diameter
  • B2: >1.5 cm in diameter, typically involving both lobes
• Stage C - extracapsular extension, or seminal vesicle invasion
• Stage D
  • Stage D1: extraprostatic disease limited to pelvic LN
  • Stage D2: widespread metastatic disease