Diagnostic ultrasound ( PDFDrive )

398 PART II Abdominal and Pelvic Sonography
TABLE 10.1 Staging of Prostate Cancer, 2010
Stage Description Comments
CLINICAL STAGING (cT__)
cTX Primary tumor cannot be assessed
cT0 No evidence of primary tumor Describes cancer on biopsy but no cancer is found at radical
prostatectomy, possibly because of microfocal cancer that is not
included in prostatectomy histologic sections. This occurs in about
0.4% of cases and in general has a good prognosis.
cT1 Clinically inapparent tumor that is
not palpable nor visible by
imaging
Describes tumors that are not palpable or visible on TRUS or mpMRI,
possibly because of size, soft consistency, or anterior location. These
may be found on TURP, where about 6% of men will have <5% of
positive chips. Prognosis is variable and about 10%-26% may have
subsequent progression especially when many chips are involved.
cT1a Tumor incidental histologic inding in
cT1b
≤5% of tissue resected
Tumor incidental histologic inding in
>5% of tissue resected
cT1c Tumor identiied by needle biopsy Describes men with impalpable disease who have positive needle biopsy
(e.g., after screening showed elevated PSA).
cT2 Tumor conined within prostate Describes palpable organ-conined tumors.
Invasion into the prostatic apex or into (but not beyond) the prostatic
capsule is included in T2.
cT2a Tumor involves ≤ 1 2 of one lobe cT2a and cT2b tumors involve only one lobe and cT2c both lobes.
cT2b
cT2c
cT3
cT3a
T3b
T4
Tumor involves > 1 2 of one lobe but
not both lobes
Tumor involves both lobes
Tumor extends through the
prostate capsule
However, pathologic examination suggests this distinction is arbitrary
because most tumors are multifocal and present in both lobes, and
prognosis also depends on tumor volume and grade and not just
indings of palpation and ultrasound.
Describes tumors with extracapsular extension, a poor prognostic factor.
Pathologically it manifests as cancer in adjacent fat, neurovascular
bundles, anterior muscle, or bladder neck or invading seminal vesicles.
Seminal vesicle invasion may occur via extension along ejaculatory
ducts, direct invasion from prostate, or rarely discontinuous metastasis.
Extracapsular extension (unilateral or bilateral)
Tumor invades seminal vesicle(s)
Tumor is ixed or invades adjacent structures other than seminal vesicles such as external sphincter
rectum, bladder, levator muscles, and/or pelvic wall
PATHOLOGIC STAGING (pT)
pT2 Organ conined
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
pT3b Seminal vesicle invasion
pT4 Invasion of rectum, levator muscles, and/or pelvic wall
Regional Lymph Nodes (N)
Based on clinical and/or pathologic assessment
NX Regional lymph nodes were not assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional lymph nodes(s)
Distant Metastasis (M)
Distant nodes are deemed metastases
M0 No distant metastasis
M1 Distant metastasis
M1a Nonregional lymph node(s)
M1b Bone(s)
M1c Other sites with or without bone disease
mpMRI, Multiparametric magnetic resonance imaging; PSA, prostate-speciic antigen; TRUS, transrectal ultrasound; TURP, transurethral
resection of the prostate.
With permission from AJCC. American Joint Committee on Cancer: Prostate Cancer Staging: American Joint Committee on Cancer; 2010. Cited
21 May 2016. 7. Available from: https://cancerstaging.org/references-tools/quickreferences/Documents/ProstateSmall.pdf. 103