AJCC and TNM staging for prostate adenocarcinoma

AJCC and TNM staging for prostate adenocarcinoma

AJCC TNM Staging System of Prostate Adenocarcinoma

T = Primary Tumor

Clinical

• TX Primary Tumor cannot be assessed
• T0 No evidence of primary tumor
• T1 Clinically inapparent tumor neither palpable nor visible by imaging
  • T1a Tumor incidental histologic finding in 5% or less of tissue resected
  • T1b Tumor incidental histologic finding in more than 5% of tissue resected
  • T1c Tumor identified by needle biopsy (for example, because of elevated PSA)
• T2 Tumor confined within prostate ¹1 Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c.
  • T2a Tumor involves one-half of one lobe or less
  • T2b Tumor involves more than one-half of one lobe but not both lobes
  • T2c Tumor involves both lobes
• T3 Tumor extends through prostate capsule ²2 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)
  • T3b Tumor invades seminal vesicle(s)
• T4 Tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall

Pathologic (pT) 3 There is no pathologic T1 classification.

• pT2 Organ confined
  • pT2a Unilateral, one-half of one side or less
  • pT2b Unilateral, involving more than one-half of side but not both sides
  • pT2c Bilateral disease
• pT3 Extraprostatic extension
  • pT3a Extraprostatic extension or microscopic invasion of bladder neck ⁴4 Positive surgical margin should be indicated by an R1 descriptor (residual microscopic disease).
  • pT3b Seminal vesicle invasion
• pT4 Invasion of rectum, levator muscles, and/or pelvic wall

N = Regional Lymph Nodes

Clinical

• NX Regional lymph nodes were not assessed
• N0 No regional lymph node metastasis
• N1 Metastasis in regional lymph node(s)

Pathologic

• pNX Regional nodes not sampled
• pN0 No positive regional nodes
• pN1 Metastases in regional node(s)

M = Distant Metastasis ⁵5 When more than one site of metastasis is present, the most advanced category is used. pM1c is most advanced.

• M0 No distant metastasis
• M1 Distant metastasis
  • M1a Non-regional lymph node(s)
  • M1b Bone(s)
  • M1c Other site(s) with or without bone disease

Anatomic Stage/Prognostic Groups 6 When either PSA or Gleason is not available, grouping should be determined by T stage and/or either PSA or Gleason as available.

(From Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. New York: Springer; 2010.)

Group
	T	N	M	PSA	Gleason
I	T1a–c	N0	M0	PSA <10	Gleason ≤6
T2a	N0	M0	PSA <10	Gleason ≤6
T1–2a	N0	M0	PSA X	Gleason X
IIA	T1a–c	N0	M0	PSA <20	Gleason 7
T1a–c	N0	M0	PSA ≥10<20	Gleason ≤6
T2a	N0	M0	PSA ≥10<20	Gleason ≤6
T2a	N0	M0	PSA <20	Gleason 7
T2b	N0	M0	PSA <20	Gleason ≤7
T2b	N0	M0	PSA X	Gleason X
IIB	T2c	N0	M0	Any PSA	Any Gleason
T1–2	N0	M0	PSA ≥20	Any Gleason
T1–2	N0	M0	Any PSA	Gleason ≥8
III	T3a–b	N0	M0	Any PSA	Any Gleason
IV	T4	N0	M0	Any PSA	Any Gleason
Any T	N1	M0	Any PSA	Any Gleason
Any T	Any N	M1	Any PSA	Any Gleason

• The management of prostate cancer is in rapid evolution.
• Any T3 lesion (i.e., primary tumor extending beyond the prostate capsule) indicates at least stage III prostate cancer, and any T4 lesion (i.e., primary tumor invading adjacent structures other than the seminal vesicles), N1 lesion (i.e., presence of regional nodal metastasis), or M1 lesion (i.e., presence of distant metastasis) indicates stage IV prostate cancer.
• Currently, stage I and II prostate adenocarcinomas are usually treated with local therapy such as radical prostatectomy or radiation therapy, whereas stage III and IV prostate adenocarcinomas are usually treated with nonsurgical multimodal therapy including systemic and radiation therapies.

What is Prostate Adenocarcinoma?

• Prostatic adenocarcinoma (PAC) is the most common form of cancer in men. It can be divided into sporadic and hereditary forms.
• Prostatic intraepithelial neoplasia (PIN) characterized by intra-acinar proliferation of cells with nuclear aplasia has been identified as a precursor for PAC.
• De novo DNA hypermethylation appears to be an early sign of prostatic carcinogenesis as well as epigenetic gene silencing of numerous other genes.
• In this context, several molecular alterations have been associated with PAC initiation and progression, such as in the tumor suppressor genes PTEN, CDKN1B, and TP53 as well as the oncogenes MYC (encoding c-myc) and BCL2.
• Furthermore, the cell cycle checkpoint gene CHEK2 was found to be an inherited prostate cancer susceptibility gene.