Radiation Oncology/Prostate/Staging

From Wikibooks, open books for an open world
Jump to: navigation, search

Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

Edit this

Prostate: Main Page | Prostate Overview | Screening and Prevention | Workup | Natural History | External Beam RT | IMRT | Androgen Suppression Therapy | Brachytherapy | Protons | Prostatectomy | Adjuvant RT after Prostatectomy | Salvage RT | Chemotherapy | Localized prostate cancer | Node Positive | Advanced disease | Recurrence after RT | Cryotherapy | RTOG Prostate Trials | Randomized Evidence


Prostate Cancer Staging

AJCC[edit]

Current Staging[edit]

AJCC 7th Edition (2009)

Note: new staging incorporates Gleason + PSA for risk group determination

Primary Tumor:

  • T1 - clinically inapparent tumor neither palpable nor visible by imaging
    • 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)
  • T2 - confined within prostate
    • 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
  • T3 - extends through the prostate capsule (note: invasion into the prostatic apex or into, but not beyond, the prostatic capsule is classified not as T3 but as T2.)
    • T3a - extracapsular extension (unilateral or bilateral) or microscopic invasion of bladder neck
    • 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

Regional Lymph Nodes:

  • 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

Distant Metastases:

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


Stage Grouping:

Note: the AJCC staging manual distinctly lists these as "groups" in contrast to other tumor sites where they are listed as "stage"
  • Group I
    T1a-c N0 M0, PSA < 10, Gleason ≤ 6
    T2a N0 M0, PSA < 10, Gleason ≤ 6
    T1-2a N0 M0, PSA X, Gleason X
  • Group IIA
    T1a-c N0 M0, PSA < 20, Gleason 7
    T1a-c N0 M0, PSA ≥ 10 < 20, Gleason ≤ 6
    T2a-b N0 M0, PSA < 20, Gleason ≤ 7 (excluding those that meet criteria for Group I)
    T2b N0 M0, PSA X, Gleason X
  • Group IIB
    T2c N0 M0, Any PSA, Any Gleason
    T1-2 N0 M0, PSA ≥ 20, Any Gleason
    T1-2 N0 M0, Any PSA, Gleason ≥ 8
  • Group III
    T3a-b N0 M0, Any PSA, Any Gleason
  • Group IV
    T4 N0 M0, Any PSA, Any Gleason
    N1, Any PSA, Any Gleason
    M1, Any PSA, Any Gleason
Note: when either PSA or Gleason is not available, grouping should be determined by T stage and/or either PSA or Gleason as available
  • Correlation with risk groups for localized disease -- I is "low risk" (PSA < 10, G ≤ 6), IIA is "intermediate risk" (roughly, PSA 10-20, or G7 and PSA<20), IIB is "high risk" (T2c or PSA≥20 or G≥8).

Changes from 6th Edition:

  • New stage groupings incorporate Gleason + PSA
  • Microscopic bladder neck invasion (previously T4) is now T3a

Older staging systems[edit]

AJCC 6th Edition (2002)
Primary Tumor:

  • 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

Regional Lymph Nodes

  • 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

Distant Metastases:

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

Stage Grouping:

  • 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)

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.

Jewett Whitmore Staging[edit]

  • 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