Scenario: PSA Elevated 7.5, DRE: Prostate nodule present right lobe suspicious for malignancy. Prostate biopsy confirmed bilateral Adenocarcinoma Gleason 3+3
Question: How would the cT be assigned?
- cT1c Tumor identified by needle biopsy found in one or both sides, but not palpable
- cT2 Tumor is palpable and confined to organ
- cT2a Tumor Involves ½ of one side or less
- cT2b Tumor involves more than ½ of one side but not both sides
- cT2c Tumor involves both sides
Answer & Rationale: cT2 Tumor is palpable and confined to organ
AJCC 8th Edition Chapter 58 Prostate Rules for Clinical Classification: The primary clinical tumor assessment includes the information from the DRE of the prostate. Neither imaging information nor tumor laterality information from the prostate biopsy should be used for clinical staging. A tumor that is found in one or both sides by needle biopsy, but is not palpable or visible by imaging, is classified as T1c. Clinical T category should always reflect DRE findings only.
The DRE only stated “right nodule present” without any indication of how much of the lobe was involved. We also cannot use the information from the biopsy which indicated bilateral disease, so the best we can do is assign a cT2.
Question: Can this case be assigned a clinical stage?
Answer & Rationale: If all T2 scenarios for that grade &PSA derived the same stage, then you could assign a stage group. In this scenario however, the combinations derive different stage groups, so a specific stage may not be assigned, enter a “99” in clinical Stage Group Field.
Question: How would EOD primary tumor be assigned?
- 200 Involves one-half of one side or less (clinically apparent/palpable)
- 210 More than one-half of one side but not both sides (clinically apparent/palpable)
- 220 Involves both lobes/sides (clinically apparent/palpable)
- 250 Confined to prostate, unknown lobe involvement (clinically apparent/palpable)
Answer & Rationale: 250 Confined to prostate, unknown lobe involvement (clinically apparent/palpable)
This field is based on the DRE whether or not the tumor is clinically apparent or inapparent. Do not use biopsy results to code this field UNLESS they prove extraprostatic extension.