Revised March 2009
4.1 Classification Criteria
Link to the current TNM system (UICC 1997): http://www.cancer.gov/cancertopics/pdq/treatment/prostate/healthprofessional/allpages#Section_18
T - Primary Tumour
| TX |
primary tumour cannot be assessed |
| TO |
no evidence of primary tumour |
| T1 |
clinically inapparent tumour not palpable or visible by imaging |
| |
T1a |
tumour incidental histological finding in 5% or less of tissue resected |
| |
T1b |
tumour incidental histological finding in more than 5% of tissue resected |
| |
T1c |
tumour identified by needle biopsy (e.g., because of elevated PSA) |
| T2* |
tumour confined within the prostate |
| |
T2a |
tumour involves one lobe |
| |
T2b |
tumour involves both lobes |
| T3** |
tumour extends through the prostatic capsule |
| |
T3a |
extracapsular extension (unilateral or bilateral) |
| |
T3b |
tumour invades seminal vesicle(s) |
| T4 |
tumour is fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall |
T2 & T3 apply only to adenocarcinomas. Transitional cell carcinoma of the prostate is classified as a urethral tumour (5.5.2.1).
* tumour found in one or both lobes by needle biopsy, but not palpable or visible by imaging is classified as T1c
** invasion into the prostatic apex or into (but not beyond) the prostatic capsule is not classified as T3, but as T2.
N - Regional Lymph Nodes
The regional lymph nodes are the nodes of the true pelvis which essentially are the pelvic nodes below the bifurcation of the common iliac arteries. Laterality does not affect the N classification.
| NX |
regional lymph nodes cannot be assessed |
| NO |
no regional lymph node metastasis |
| N1 |
regional lymph node metastasis |
M - Distant Metastasis
| MX |
distant metastasis cannot be assessed |
| MO |
no distant metastasis |
| M1 |
distant metastasis |
| |
M1a |
non-regional lymph node(s) |
| |
M1b |
bone(s) |
| |
M1c |
other site(s) |
Note: when more than one site of metastasis is present, the most advanced category should be used.
4.2 Staging Diagram 
4.3 Investigations for Staging
Assessment for patients who are being considered for curative (radical) surgery or radiation should consist of:
- History and physical examination
- CBC, BUN, creatinine, urinalysis
- PSA (which should be done prior to biopsy)
- Radionuclide bone scan is indicated only in patients with intermediate or high-risk disease (as defined in 5. Management)
Chest x-ray Other investigations:
- CT scans are not routinely indicated except in high-risk patients (serum PSA >30, or advanced high-grade tumours)
- Prostatic acid phosphatase is no longer indicated and is no longer a useful tumour marker having been replaced by PSA