Pathological staging of prostate cancer

The microscopic diagnosis of prostate adenocarcinoma is based on a combination of histology and cytology. This is because the pleomorphism of cells is not a constant feature of prostate adenocarcinoma. Pathological examinations often rely on abnormal glandular tissue structure and abnormal relationships between glands and stroma to make a diagnosis. So, what is the pathological staging of prostate cancer?

Pathological staging

The pathological staging of prostate cancer is closely related to the clinical staging. Currently, there are four different pathological staging systems for prostate cancer used clinically. Pathological staging is based on clinical staging, and only P is added before the staging. The four staging systems are the ABCD system, the TNM system, the OSCC system, and the ultrasound staging system. Among these four systems, the first two are widely used, while the TNM system is detailed and is the pathological staging system recommended by the International Cancer Association, so it is introduced below.

(1) T refers to the presence or absence of primary tumor.

PTx: primary tumor cannot be estimated.

PT0: No evidence of primary tumor.

PT1: Clinical examination did not find a tumor but pathological examination showed cancer.

PT1a: Cancer is found in the removed prostate tissue and the volume of the cancer is less than or equal to 5 percent of the removed tissue.

PT1b: Cancer is found in the resected prostate tissue by pathological examination, and the volume of the cancer is greater than 5% of the resected tissue.

PT1c: Prostate biopsy confirms the presence of cancer.

PT2: The tumor is confined to the prostate.

PT2a: The tumor invades 1/2 or less of one lobe of the prostate.

PT2b: The tumor invades more than 1/2 of one lobe of the prostate but less than two lobes.

TP2c: The tumor invades both lobes of the prostate.

PT3: The tumor extends through the prostate capsule.

PT3a: Unilateral extracapsular extension.

PT3b: Bilateral extracapsular extension.

PT3c: Tumor invades the seminal vesicles.

PT4: The tumor invades adjacent tissues except the seminal vesicle and is fixed to them.

PT4a: The tumor invades the bladder neck and/or external sphincter and/or rectum.

PT4b: The tumor invades the levator ani muscle and/or is fixed to the pelvic wall.

(2) N refers to the presence or absence of lymph node metastasis.

Nx: Lymph node metastasis cannot be estimated.

N0: No regional lymph node metastasis.

N1: There is one lymph node metastasis, and the largest diameter of the lymph node is less than or equal to 2 cm.

N2: There is one lymph node metastasis, with the largest diameter between 2 and 5 cm, or there are multiple lymph nodes metastasis, with the largest diameters all less than 5 cm.

N3: There is one lymph node metastasis, the largest diameter of which is greater than 5 cm.

(3) M refers to the presence or absence of distant metastasis.

Mx: It is impossible to estimate whether there is distant metastasis.

M0: No distant metastasis.

M1: There is distant metastasis.

M1a: There is distant metastasis but no regional lymph node metastasis.

M1b: Bone metastasis

M1c: metastasis to other parts of the body.