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Difference between revisions of "Prostate cancer staging"
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| T3a | | T3a | ||
| extension into periprostatic soft tissue | | extension into periprostatic soft tissue (see ''[[extraprostatic extension]]'') ''or'' bladder neck invasion | ||
| | | | ||
|- | |- | ||
| T3b | | T3b | ||
| extension into the muscle of the [[seminal vesicles]] (see ''[[seminal vesicle invasion]]'') | | extension into the muscle of the [[seminal vesicles]] (see ''[[seminal vesicle invasion]]'') | ||
| | | | ||
|- | |- | ||
| T4 | | T4 | ||
| extension into a surrounding anatomical structure, e.g. [[urinary bladder | | extension into a surrounding anatomical structure, e.g. [[urinary bladder]] | ||
| bladder neck invasion is T3b | | bladder neck invasion is T3b | ||
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#Malignant cells directly adjacent to peri-prostatic adipose tissue. | #Malignant cells directly adjacent to peri-prostatic adipose tissue. | ||
Notes: | |||
*The apex of the prostate gland may have some skeletal muscle. Thus, it is difficult to define extension at this site. EPE is not called at the apex by some pathologists; however, it is generally believed to exist.<ref name=pmid20802467/> | *The apex of the prostate gland may have some skeletal muscle. Thus, it is difficult to define extension at this site. EPE is not called at the apex by some pathologists; however, it is generally believed to exist.<ref name=pmid20802467/> | ||
*The anterior prostate has fibromuscular stroma that is difficult to separate from the extraprostatic tissue.<ref name=pmid18049129>{{cite journal |authors=Fine SW, Al-Ahmadie HA, Gopalan A, Tickoo SK, Scardino PT, Reuter VE |title=Anatomy of the anterior prostate and extraprostatic space: a contemporary surgical pathology analysis |journal=Adv Anat Pathol |volume=14 |issue=6 |pages=401–7 |date=November 2007 |pmid=18049129 |doi=10.1097/PAP.0b013e3181597a9c |url=}}</ref> | |||
**Anterior fibromuscular stroma (AFMS) versus extraprostatic extension (EPE): true EPE is proposed to be into the fat ''or'' thick rounded muscle bundles.<ref name=pmid18049129/> | |||
=====Prostate biopsy===== | =====Prostate biopsy===== | ||
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*Bladder neck invasion is '''pT3a'''.<ref name=pmid23225909>{{Cite journal | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }}</ref> | *Bladder neck invasion is '''pT3a'''.<ref name=pmid23225909>{{Cite journal | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }}</ref> | ||
*Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref> | *Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref> | ||
*Bladder neck involvement can be seen without extraprostatic extension.<ref name=pmid15378493>{{Cite journal | last1 = Poulos | first1 = CK. | last2 = Koch | first2 = MO. | last3 = Eble | first3 = JN. | last4 = Daggy | first4 = JK. | last5 = Cheng | first5 = L. | title = Bladder neck invasion is an independent predictor of prostate-specific antigen recurrence. | journal = Cancer | volume = 101 | issue = 7 | pages = 1563-8 | month = Oct | year = 2004 | doi = 10.1002/cncr.20551 | PMID = 15378493 }}</ref> | |||
======Image====== | |||
<gallery> | |||
Image:Bladder neck invasion in prostate cancer -- very low mag.jpg | BNI - very low mag. (WC/Nephron) | |||
</gallery> | |||
www: | |||
*[http://www.nature.com/modpathol/journal/v24/n1/fig_tab/modpathol2010158f1.html Bladder neck margin (nature.com)].<ref name=pmid20802467>{{Cite journal | last1 = Magi-Galluzzi | first1 = C. | last2 = Evans | first2 = AJ. | last3 = Delahunt | first3 = B. | last4 = Epstein | first4 = JI. | last5 = Griffiths | first5 = DF. | last6 = van der Kwast | first6 = TH. | last7 = Montironi | first7 = R. | last8 = Wheeler | first8 = TM. | last9 = Srigley | first9 = JR. | title = International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease. | journal = Mod Pathol | volume = 24 | issue = 1 | pages = 26-38 | month = Jan | year = 2011 | doi = 10.1038/modpathol.2010.158 | PMID = 20802467 }}</ref> | |||
====Seminal vesicle invasion==== | ====Seminal vesicle invasion==== | ||
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*Immunostains useful to separate prostate carcinoma from [[SV]] are discussed in the ''[[seminal vesicle]]'' article. | *Immunostains useful to separate prostate carcinoma from [[SV]] are discussed in the ''[[seminal vesicle]]'' article. | ||
*It is not possible to differentiate the ''seminal vesicles'' and ''ejaculatory ducts'' based only on histology; thus, on biopsy one can generally comment only on ''seminal vesicle/ejaculatory duct invasion''. | *It is not possible to differentiate the ''seminal vesicles'' and ''ejaculatory ducts'' based only on histology; thus, on biopsy one can generally comment only on ''seminal vesicle/ejaculatory duct invasion''. | ||
*SVI has been subdivided into three types by pattern of spread (type I: spread along ejaculatory duct complex and into SV, type II: through prostate capsule and then into SV; type III: discontinuous spread/metastasis).<ref name=pmid16985773>{{Cite journal | last1 = Potter | first1 = SR. | last2 = Epstein | first2 = JI. | last3 = Partin | first3 = AW. | title = Seminal vesicle invasion by prostate cancer: prognostic significance and therapeutic implications. | journal = Rev Urol | volume = 2 | issue = 3 | pages = 190-5 | month = | year = 2000 | doi = | PMID = 16985773 }}</ref> | |||
===Lymph node=== | ===Lymph node=== | ||