Jewett (AUS) and TNM Staging of Prostate Carcinoma

Description

A number of staging systems are available for prostate carcinoma. The ones in common use are the Jewett (American Urological System, or AUS) and the Tumor-Nodes-Metastases (TNM) Staging Systems.

American Urological System

Extent of Disease	Additional Findings	AUS Stage
no palpable lesion		A
	focal	A1
	diffuse	A2
confined to prostate		B
	small, discrete nodule	B1
	large or multiple nodules or areas	B2
involves periprostatic area		C
	no involvement of seminal vesicles, tumor 70 g or less	C1
	involvement of seminal vesicles, tumor larger than 70 g	C2
metastatic disease		D
	pelvic lymph node metastases or urethral obstruction causing hydronephrosis	D1
	bone or distant lymph node or organ or soft tissue metastasis	D2

TNM System

Extent of Disease	Additional Findings	TNM
primary cannot be assessed		TX
no evidence of primary tumor		T0
clinically inapparent tumor not palpable or visible by imaging		T1
	tumor incidental finding in <=5% of tissue resected	T1a
	tumor incidental histologic finding in > 5% of tissue resected	T1b
	tumor identified by needled biopsy (may be in one or both lobes)	T1c
tumor confined to the prostate	includes nonpenetrating invasion into capsule and invasion into apex of prostate	T2
	tumor involves less than half a lobe or less	T2a
	tumor involves more than half of a lobe but not both lobes	T2b
	tumor involves both lobes	T2c
tumor extends through the prostatic capsule		T3
	unilateral extracapsular extension	T3a
	bilateral extracapsular extension	T3b
	tumor invades the seminal vesicles	T3c
tumor is fixed or invades adjacent structures other than the seminal vesicles		T4
	tumor invades any of the following: bladder neck, external sphincter or rectum	T4a
	tumor invades levator muscles and/or is fixed to the pelvic wall	T4b
regional lymph node involvement	cannot be assessed	NX
	no regional lymph node metastasis	N0
	metastasis in a single lymph node, 2 cm or less in greatest dimension	N1
	metastasis in a single lymph node, more than 2 cm but not more than 5 cm in greatest dimension	N2
	multiple lymph node metastases, none more than 5 cm in greatest dimension	N2
	metastasis in a lymph node more than 5 cm in greatest dimension	N3
distant metastasis	cannot be assessed	MX
	present	M1
	present in nonregional lymph nodes	M1a
	present in bone	M1b
	present in other sites	M1c
histopathology	grade cannot be assessed	GX
	well differentiated	G1
	moderately differentiated	G2
	poorly differentiated	G3
	undifferentiated	G4

Note: variants in TNM system (from UICC TNM Atlas)

• T1a: <= 3 microscopic foci of carcinoma

• T1b: > 3 microscopic foci of carcinoma

• T2a: tumor <= 1.5 cm in greatest dimension with normal tissue on at least 3 sides

• T2b: tumor < 1.5 cm in greatest dimension or in more than 1 lobe

• T3: tumor invades into prostatic apex or into or beyond the prostate capsule or bladder neck or seminal vesicle, but is not fixed

Regional lymph nodes:

(1) pelvic

(2) hypogastric

(3) obturator

(4) internal iliac

(5) external iliac

(6) periprostatic

(7) sacral

Distant lymph nodes:

(1) aortic (para-aortic, lumbar)

(2) common iliac

(3) deep inguinal

(4) superficial inguinal (femoral)

(5) supraclavicular

(6) cervical

(7) scalene

(8) retroperitoneal

TNM	N	M	G	Stage
T1a	N0	M0	G1	0
T1a T1b T1c T1	N0 N0 N0 N0	M0 M0 M0 M0	G2, G3, G4 any G any G any G	I
T2	N0	M0	any G	II
T3	N0	M0	any G	III
T4 any T any T any T any T	N0 N1 N2 N3 any N	M0 M0 M0 M0 M1	any G	IV

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Jewett (AUS) and TNM Staging of Prostate Carcinoma

Description

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