Summary Stage 2018: Prostate
Summary Stage 2018
Notes
**Prostate**
8000-8700, 8720-8790
C619
C619 Prostate gland
**Note 1:** The following sources were used in the development of this chapter
* SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf)
* SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/ssm2000/)
* Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx
* Chapter 58 *Prostate*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
**Note 2:** See the following chapters for the listed histologies
* 8710-8714, 8800-8934, 8940-9138, 9141-9582: *Soft Tissue*
* 8935-8936: *GIST*
* 9140: *Kaposi Sarcoma*
* 9700-9701: *Mycosis Fungoides*
**Note 3:** See the *Urethra* chapter for transitional cell (urothelial) carcinoma of the prostatic urethra (C680).
**Note 4:** When the only information available is a TURP, with no evidence of lymph node involvement or distant metastasis involvement, assign code 1.
**Note 5:** Imaging is not used to determine clinical extension. If a physician incorporates imaging findings into their evaluation, do not use this information.
* If it cannot be determined if the physician is using imaging, assume they are not and code the Summary Stage based on the physician’s statement
**Note 6:** If there is no information from the DRE, but the physician assigns an extent of disease, the registrar can use that.
* ***Example:*** DRE reveals prostate is "firm." Physician stages the patient as a cT2a.
* The T2a (localized) can be used since the physician has documented this
**Note 7:** Localized (code 1) can be assigned when the DRE result is not documented, or DRE not done and there is no evidence of extraprostatic extension
* ***Example 1:*** Patient with elevated PSA and positive needle core biopsy, but no documentation regarding tumor apparency (inapparent versus apparent), and there is no evidence of extraprostatic extension. No prostatectomy done
* ***Example 2:*** Pathology report from a needle core biopsy done confirming cancer. No information on PSA, DRE, Radical prostatectomy, or physician statement regarding clinical extension
* ***Example 3:*** Pathology report from a needle core biopsy done confirming cancer. No information on PSA, DRE or physician statement regarding clinical extension. Physician states imaging shows extraprostatic extension and assigns cT3a
**Note 8:** If a needle core biopsy confirms extraprostatic extension, that information can be used for Summary Stage.
**Note 9:** Involvement of prostatic urethra does not alter the Summary Stage code.
**Note 10:** "Frozen pelvis" is a clinical term which means tumor extends to pelvic sidewall(s) (code 7).
**Note 11:** When prostate cancer is an incidental finding during a prostatectomy for other reasons (for example, a cystoprostatectomy for bladder cancer), use the appropriate code for the extent of disease found.
| SS2018 |
Description |
| 0 |
In situ, intraepithelial, noninvasive |
| 1 |
Localized only (localized, NOS)
- Clinically apparent or inapparent tumor
- Confined to prostate, NOS
- Intracapsular involvement only
- Invasion into (but not beyond) prostatic capsule
- No extracapsular extension
- One or more lobes involved |
| 2 |
Regional by direct extension only
- Bladder neck
- Bladder, NOS
- External sphincter
- Extraprostatic/extracapsular extension (beyond prostate capsule), unilateral, bilateral, NOS
- Extraprostatic urethra (membranous urethra)
- Fixation, NOS
- Levator muscles
- Periprostatic tissue
- Rectovesical (Denonvillier's) fascia
- Rectum
- Seminal vesicles
- Skeletal muscle
- Through capsule, NOS
- Ureter(s) |
| 3 |
Regional lymph node(s) involved only
- Hypogastric
- Iliac, NOS
+ External
+ Internal (hypogastric) (obturator), NOS
- Pelvic, NOS
- Periprostatic
- Sacral, NOS
+ Lateral (laterosacral)
+ Middle (promontory) (Gerota's node)
+ Presacral
- Regional lymph node(s), NOS
+ Lymph node(s), NOS |
| 4 |
Regional by BOTH direct extension AND regional lymph node(s) involved
- Codes (2) + (3) |
| 7 |
Distant site(s)/lymph node(s) involved
- Distant site(s) (including further contiguous extension)
+ Bone
+ Extension to or fixation to pelvic wall or pelvic bone
+ "Frozen pelvis", NOS
+ Other organs
+ Penis
+ Sigmoid colon
+ Soft tissue other than periprostatic
- Distant lymph node(s), NOS
+ Aortic (lateral [lumbar], para-aortic, periaortic, NOS)
+ Cervical
+ Common iliac
+ Inguinal (deep, NOS)
* Node of Cloquet or Rosenmuller (highest deep inguinal)
* Superficial (femoral)
+ Retroperitoneal, NOS
+ Scalene (inferior deep cervical)
+ Supraclavicular (transverse cervical)
- Distant metastasis, NOS
+ Carcinomatosis
+ Distant metastasis WITH or WITHOUT distant lymph node(s) |
| 9 |
Unknown if extension or metastasis |
(1) Fritz AG, Ries LAG (eds). **SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998)**, National Cancer Institute, NIH Pub. No. 98-2313, Bethesda, MD, 1998
(2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001.
(3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05**. American Joint Committee on Cancer (Chicago, IL)
(4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
(5) Buyyounouski, M.K., Lin, D.W., et al. **Prostate**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
