Σταδιοποίηση σε Ca Προστάτη

 

Ca Προστάτη

AJCC Stages

Stages

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

10 ≤ PSA < 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

When either PSA or Gleason is not available, grouping should be determined by T stage &/or either PSA or Gleason as available.

(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% of tissue resected

T1b

Tumor incidental histologic finding in > 5% of tissue resected

T1c

Tumor identified by needle biopsy (e.g., because of elevated PSA)

T2

Tumor confined within prostate¹

T2a

Tumor involves ≤ 1/2 of 1 lobe

T2b

Tumor involves > 1/2 of 1 lobe but not both lobes

T2c

Tumor involves both lobes

T3

Tumor extends through the prostate capsule²

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, &/or pelvic wall

Pathologic3

 

pT2

Organ confined

pT2a

Unilateral, ≤ 1/2 of 1 side

pT2b

Unilateral, involving > 1/2 of 1 side but not both sides

pT2c

Bilateral disease

pT3

Extraprostatic extension

pT3a

Extraprostatic extension or microscopic invasion of bladder neck⁴

pT3b

Seminal vesicle invasion

pT4

Invasion of rectum, levator muscles, &/or pelvic wall

¹ Tumor found in 1 or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c. 
² Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified not as T3 but as T2. 
³ There is no pathologic T1 classification. 
4 Positive surgical margin should be indicated by an R1 descriptor (residual microscopic disease).

(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

M0

No distant metastasis

M1

Distant metastasis

M1a

Nonregional lymph node(s)

M1b

Bone(s)

M1c

Other site(s) with or without bone disease

When > 1 site of metastasis is present, the most advanced category is used (pM1c is most advanced).

(G) Histologic Grade

GX

Gleason score cannot be processed

Gleason ≤ 6

Well differentiated (slight anaplasia)

Gleason 7

Moderately differentiated (moderate anaplasia)

Gleason 8-10

Poorly differentiated/undifferentiated (marked anaplasia)

Χαρακτηριστικά Επέκτασης
  • 2 different hematogenous routes of spread
    • Backwards venous spread most common source for osteoblastic metastases
      • Prostatic and vesicle venous plexus directly to vertebral (Batson) venous plexus
        • Lumbar spine mets 3x more common than cervical spine mets
        • This pathway may represent early pattern of hematogenous spread
    • Caval route may be later route of dissemination
    • Prostatic venous plexus to iliac veins
    • Inferior vena cava to lungs
    • Lung metastases followed by dissemination to pleura, liver, adrenal glands, etc.
      • Rarely hematogenous disease will bypass lungs
  • Lymphatic route for nodal disease
  • Regional lymph nodes (N1 disease) include nodes of true pelvis; those nodes below bifurcation of common iliac arteries
    • Pelvic nodes NOS
      • 2nd most common site of nodal mets at autopsy
    • Iliac nodes (internal, external, or NOS)
    • Obturator nodes
    • Sacral nodes
    • Hypogastric nodes
  • Distant lymph nodes (M1a disease) are those outside true pelvis
  • Paraaortic nodal disease #1 most common site of nodal mets overall at autopsy
    • May result of direct nodal seeding from vertebral venous plexus in addition to lymphatic spread
    • Found more frequently when spinal mets are present than when spinal mets are absent
  • Common iliac nodes
  • Mediastinal
  • 3rd most common site of nodal mets
  • 4th most common site of nodal mets
  • Inguinal, deep and superficial nodes

Κατηγοριοποίηση (Ιστολογικοί Τύποι)
  • Adults: 95% of tumors are adenocarcinoma
  • Children: Vast majority due to rhabdomyosarcoma