Primary tumor (T)
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: Clinically inapparent tumor not 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 (e.g., because of elevated PSA)
T2: Tumor confined within prostate*
T2a: Tumor involves 1 lobe
T2b: Tumor involves both lobes
T3: Tumor extends through the prostatic capsule**
T3a: Extracapsular extension (unilateral or bilateral)
T3b: Tumor invades seminal vesicle(s)
T4: Tumor is fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall
*Note: Tumor found in 1 or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c.
**Note: Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is not classified as T3, but as T2.
Regional lymph nodes (N)
Regional lymph nodes are the nodes of the true pelvis, which essentially are
the pelvic nodes below the bifurcation of the common iliac arteries. They include the following groups (laterality does not affect the N classification): pelvic (NOS), hypogastric, obturator, iliac (internal, external, NOS), periprostatic, and sacral (lateral, presacral, promontory (Gerota's), or NOS). Distant lymph nodes are outside the confines of the true pelvis and their involvement constitutes distant metastasis. They can
be imaged using ultrasound, computed tomography, magnetic resonance imaging, or lymphangiography, and include: aortic (para-aortic, periaortic, lumbar), common iliac, inguinal, superficial inguinal (femoral), supraclavicular, cervical, scalene, and retroperitoneal (NOS) nodes.
NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in regional lymph node or nodes
Abbreviation: NOS, not otherwise specified.
Distant metastasis*** (M)
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis
M1a: Nonregional lymph node(s)
M1c: Other site(s)
***Note: When more than 1 site of metastasis is present, the most advanced
category (pM1c) is used.
Histopathologic grade (G)
GX: Grade cannot be assessed
G1: Well differentiated (slight anaplasia)
G2: Moderately differentiated (moderate anaplasia)
G3-4: Poorly differentiated or undifferentiated (marked anaplasia)
AJCC stage groupings
T1a, N0, M0, G1
T1a, N0, M0, G2, 3-4
T1b, N0, M0, Any G
T1c, N0, M0, Any G
T1, N0, M0, Any G
T2, N0, M0, Any G
T3, N0, M0, Any G
T4, N0, M0, Any G
Any T, N1, M0, Any G
Any T, Any N, M1, Any G
The Jewett staging system is as described below.
Stage A is clinically undetectable tumor confined to the prostate gland and is an incidental finding at prostatic surgery.
Substage A1: well-differentiated with focal involvement, usually left untreated
Substage A2: moderately or poorly differentiated or involves multiple foci in the gland
Stage B is tumor confined to the prostate gland.
Substage B0: nonpalpable, PSA-detected 17
Substage B1: single nodule in 1 lobe of the prostate
Substage B2: more extensive involvement of 1 lobe or involvement of both lobes
Stage C is a tumor clinically localized to the periprostatic area but extending
through the prostatic capsule; seminal vesicles may be involved.
Substage C1: clinical extracapsular extension
Substage C2: extracapsular tumor producing bladder outlet or ureteral obstruction
Stage D: metastatic disease.
Substage D0: clinically localized disease (prostate only) but persistently elevated enzymatic serum acid phosphatase titers
Substage D1: regional lymph nodes only
Substage D2: distant lymph nodes, metastases to bone or visceral organs
Substage D3: D2 prostate cancer patients who relapsed after adequate endocrine therapy