Summary Stage 2018: Prostate

Summary Stage 2018

Notes

**Prostate** 8000-8700, 8720-8790 C619 C619 Prostate gland **Note 1:** **Sources 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:** **Other Summary Stage Chapters with Prostate sites** * **GIST**: 8935-8936 * **Kaposi Sarcoma**: 9140 * **Mycosis Fungoides**: 9700-9701 * **Soft Tissue**: 8710-8714, 8800-8934, 8940-9138, 9141-9582 **Note 3:** **Transitional cell carcinoma of prostatic urethra** * See the *Urethra* chapter for transitional cell (urothelial) carcinoma of the prostatic urethra (C680). **Note 4:** **TURP only** * When the only information available is a TURP, with no evidence of lymph node involvement or distant metastasis involvement, assign code 1. **Note 5:** **Do not use imaging** * 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:** **No DRE, but physician assigns stage** * 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 cancers** * 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:** **Extraprostatic extension** * If a needle core biopsy confirms extraprostatic extension, that information can be used for Summary Stage. **Note 9:** **Involvement of prostatic urethra** * Involvement of prostatic urethra does not alter the Summary Stage code. **Note 10:** **Frozen pelvis** * "Frozen pelvis" is a clinical term which means tumor extends to pelvic sidewall(s) (code 7). **Note 11:** **Incidental finding** * 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.

NAACCR Item

NAACCR #764

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

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