Summary Stage 2018: Prostate
Summary Stage 2018
Notes
**Prostate**
8000-8700, 8720-8790, 8940-8960, 8965-8983, 9000, 9050-9111, 9270, 9300-9312, 9340-9363, 9380-9539, 9541
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, 8963-8964, 8990-8992, 9010-9045, 9120-9138, 9141-9262, 9271-9290, 9320-9330, 9364-9373, 9540, 9542-9582
**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:** **Using findings from needle core biopsy**
* Do **not use findings from the needle core biopsy to code extension**. Only the results from the DRE can be used to code EOD Primary Tumor. (**See Note 9** for exception when the biopsy proves **extraprostatic extension**)
***Example:*** Patient has elevated PSA. DRE done which showed no abnormalities. Pathology report from needle core biopsies shows that both lobes are involved. Summary Stage would be 1, *tumor Identified by needle core biopsy* due to elevated PSA.
**Note 7:** **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 8:** **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 9:** **Extraprostatic extension**
* If a needle core biopsy confirms extraprostatic extension, that information can be used for Summary Stage.
**Note 10:** **Involvement of prostatic urethra**
* Involvement of prostatic urethra does not alter the Summary Stage code.
**Note 11:** **Frozen pelvis**
* "Frozen pelvis" is a clinical term which means tumor extends to pelvic sidewall(s) (code 7).
**Note 12:** **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.
| 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
