Register
Login
×

Prostate Cancer Staging: TNM Classification


Prostate cancer staging helps to determine the disease prognosis and to select an appropriate treatment strategy.

TNM is the most commonly used staging system for prostate cancer. It uses mainly 5 parameters: “T” stands for “Tumor”; “N” for “Lymph Nodes”; and “M” for “Metastasis”. the PSA level; and the Grade group (based on the Gleason score).

Numbers and/or letters after T (0, 1a, 1b, 1c, 2a, 2b, 2c, 3a, and 3b), N (0 and 1), and M (0 and 1) provide more details about each of these parameters.

PSA level is indicated in nanograms per milliliter (ng/mL). Grading (1 to 5) is assessed based on Gleason score (as described below).

Gleason scoring system involves scoring of prostate cancer based on the extent of abnormality observed in the collected biopsy samples (usually the Gleason score ranges from 3 to 5 for a single biopsy sample).

Since prostate cancer is a multifocal disease, the score for different biopsy samples collected from the same patient may differ. Thus, score of specimen with most predominant Gleason score is added to the highest Gleason score observed, to give overall Gleason score (that may range from 6 to 10). Further, Gleason grade groups (1 to 5) are derived according to the following table:

Gleason Grade Group Gleason Score Gleason Pattern
1 </=6 </= 3+3
2 7 3+4
3 7 4+3
4 8 4+4, 5+3, 3+5
5 9 or 10 4+5, 5+4, 5+5

Once T, N, M, PSA, and grade group are determined through different diagnostic techniques, his information is combined to assign an overall stage (from 0 to IV) to the disease.

Prostate Cancer - T Staging (T1, T2) - Infographic
Prostate Cancer - T Staging (T1, T2)
Prostate Cancer - T Staging (T3, T4) - Inforgraphic
Prostate Cancer - T Staging (T3, T4)
Prostate Cancer - N and M Staging - Infographic
Prostate Cancer - N and M Staging
STAGE TNM Score, PSA (ng/mL), Grade Group (GG) Description
I T1a-2 N0 M0 PSA<10 GG=1 Tumor that is not palpable or clinically inapparent to tumor palpable and confined to the prostate. No spread to nearby lymph nodes or distant body parts. PSA level is less than 10 and the grade group is 1.
IIA T1a-2a N0 M0 PSA>/=10,<20 GG=1 Tumor that is not palpable or clinically inapparent to tumor involving less than half of one lobe of the prostate. No spread to nearby lymph nodes or distant body parts. PSA level is greater than or equal to 10 but less than 20 and the grade group is 1.
OR
T2b-2c N0 M0 PSA<20 GG=1 Tumor involving more than half of one lobe of the prostate to tumor involving both lobes of the prostate. No spread to nearby lymph nodes or distant body parts. PSA level is less than 20 and the grade group is 1.
IIB T1-2 N0 M0 PSA<20 GG=2 Tumor that is not palpable or clinically inapparent to tumor involving both lobes of the prostate. No spread to nearby lymph nodes or distant body parts. PSA level is less than 20 and the grade group is 2.
IIC T1-2 N0 M0 PSA<20 GG=3-4 Tumor that is not palpable or clinically inapparent to tumor involving both lobes of the prostate. No spread to nearby lymph nodes or distant body parts. PSA level is less than 20 and the grade group is from 3 to 4.
IIIA T1-2 N0 M0 PSA>/=20 GG=1-4 Tumor that is not palpable or clinically inapparent to tumor involving both lobes of the prostate. No spread to nearby lymph nodes or distant body parts. PSA level is greater than or equal to 20 and the grade group is from 1 to 4.
IIIB T3-4 N0 M0 Any PSA GG=1-4 Tumor with extraprostatic extension to tumor invading adjacent structures like bladder, rectum, perineal body, or pelvic wall. No spread to nearby lymph nodes or distant body parts. Any value for PSA level and the grade group is from 1 to 4.
IIIC Any T N0 M0 Any PSA GG=5 Tumor of any size or extension. No spread to nearby lymph nodes or distant body parts. Any value for PSA level and the grade group is 5.
IVA Any T N1 M0 Any PSA Any GG Tumor of any size or extension. The cancer cells have spread to regional lymph node without spread to any distant body part. Any value for PSA level and any grade group from 1 to 5.
IVB Any T Any N M1 Any PSA Any GG Tumor of any size or extension. The cancer cells may/may not spread to regional lymph nodes, with spread to a distant body parts such as bones, lungs, liver, brain, etc. Any value for PSA level and any grade group from 1 to 5.

Join our PROSTATE CANCER COMMUNITY for cancer fighters and survivors across the globe.

In the following video, Cancerbro explains the anatomy of prostate gland that will help to understand the STAGING better.

Now let's look the at the TNM STAGING of prostate cancer.

Join our community of fighters and survivors, motivate and uplift each other to fight cancer together.