Staging was clarified by DRE, PSA, number and site of positive puncture biopsy stitches, bone scan, CT, MRI, and lymph node dissection. The TNM staging system of AJCC 2002 is introduced.
1. T-stage indicates the local condition of the primary tumor, which is mainly determined by DRE and MRI, and the number and site of positive prostate puncture biopsies, pathological grading of the tumor and PSA can assist in staging.
2. N-stage indicates the lymph node condition, and only through lymph node dissection can we accurately understand the lymph node metastasis. n-stage is important for patients who are ready for radical therapy, and patients with stage below T2, PSA <20ng/ml and Gleason score <6 have less than 10% chance of lymph node metastasis and can be reserved for lymph node dissection. < p="">
3, M staging is mainly for skeletal metastases, and bone scan is the most suitable test. Especially for patients with poor pathological differentiation (Gleason score >7) or PSA >20ng/ml, bone scan should be routinely performed.
TNM staging of prostate cancer (AJCC, 2002)
Primary tumor (T)
Clinical
Pathology (pT)*
Tx Primary tumor cannot be evaluated
pT2* confined to the prostate
T0 No evidence of primary tumor
pT2a Tumor limited to 1/2 of a single lobe
T1 Clinically occult tumor that cannot be palpated and detected by imaging
pT2b Tumor exceeding 1/2 of a single lobe but limited to that lobe
T1a Incidental tumor volume < 5% of the resected tissue volume< p="">
pT2c Tumor invading both lobes
T1b Incidental tumor volume > 5% of the resected tissue volume
pT3 Breakthrough of the prostate
T1c Tumor detected by puncture biopsy (e.g. due to elevated PSA)
pT3a Breakthrough of the prostate
T2 Tumor confined to the prostate
pT3b Invasion of seminal vesicles
T2a Tumor limited to 1/2 of a single lobe (≤1/2)
pT4 Invasion of bladder and rectum
T2b Tumor exceeding 1/2 of a single lobe but limited to that single lobe (1/2-1)
T2c Tumor invades both lobes
T3 Tumor breaches the prostate envelope**
T3a Tumor invades the peritoneum (unilateral or bilateral)
T3b Tumor invades seminal vesicle
T4 Tumor fixation or invasion of adjacent tissue structures other than seminal vesicles, such as bladder neck, external urethral sphincter, rectum, anal levator and/or pelvic wall
Regional lymph nodes (N)***
Clinical
Pathology
Nx Regional lymph nodes cannot be evaluated
PNx No regional lymph node sampling specimen
N0 No regional lymph node metastasis
pN0 No regional lymph node metastasis
N1 Regional lymph node metastasis
pN1 Regional lymph node metastasis
Distant metastasis (M) ****
Mx
M0
M1
M1a with lymph node metastases other than regional lymph nodes
M1b Bone metastasis
M1c Metastasis from other organs and tissues
*Note: Single-lobe or two-lobe tumors found by puncture biopsy but not clinically palpable or detectable by imaging are designated as T1c.
**Note: those invading the apical part of the prostate or the prostatic envelope but not breaking through the envelope are designated as T3, not T2.
***Note: metastases not exceeding 0,2 cm are designated as pN1mi.
**** Note: When there is more than one metastasis, it is the most advanced stage
(D) Risk factor analysis of prostate cancer
According to serum PSA, Gleason score and clinical stage, prostate cancer is classified into low, intermediate and high risk categories in order to guide treatment and judge prognosis [15].
Low risk
Intermediate risk
High risk
PSA (ng/ml)
4 to 10
10.1～20
＞20
Gleason score
≤6
7
＞8
Clinical stage
≤T2a
T2b
≥T2c