Clinical T

This input is used for staging

Notes

**Note 1:** Assign 88 for in situ cases (behavior code /2). TNM does not include an in situ category for prostate tumors. **Note 2:** **Clinically inapparent and apparent tumors**. When clinical apparency cannot be determined, assign T2. * **Clinically inapparent tumors** are neither palpable nor "reliably" visible by imaging. Physician documentation of a DRE that does not mention a palpable "tumor", "mass", or "nodule" can be inferred as inapparent. This would include findings limited to benign prostate enlargement/hypertrophy * **Clinically apparent tumors** are palpable or "reliably" visible by imaging. If a clinician documents a "tumor", "mass", or "nodule" by physical examination, this can be inferred as apparent. "Tumor", "mass", or "nodule" on imaging can only be used by the registrar if the managing clinician/urologist uses it * Do **not** infer inapparent or apparent tumor based on the registrar's interpretation of other terms in the DRE or imaging reports. A physician assignment of T1 or T2 is also a clear statement of inapparent or apparent respectively. Assign T2 in the absence of a clear physician's statement of inapparent or apparent **Note 3:** The digital rectal examination (DRE) is the "gold standard" for clinical staging and the quality of imaging for staging is not sufficiently uniform to make it part of routine staging. Therefore, the registrar should not use imaging to determine an apparent tumor unless the managing clinician/urologist has used it in staging (herein termed "reliably" visible on imaging). If there is a discrepancy between a stage documented on an imaging report and a stage documented by a managing clinician/urologist, the latter takes precedence. **Note 4:** T1a, T1b, T1c and T1 are used only for **clinically inapparent tumors** (see Note 2) and/or incidentally found microscopic carcinoma (latent, occult) in one or both lobes. Within this range, give priority to codes T1a and T1b over T1. Do not assign T1a, T1b or T1 [NOS] for needle core biopsy. Assign T1c when tumor is found in one lobe or both lobes by needle biopsy, but is not palpable or "reliably" visible by imaging. Since T1c is used to measure screening detected cases, it is important to only apply code T1c when it is clearly an inapparent case. **Note 5:** T2a, T2b, T2c and T2 are used only for **clinically apparent tumors** (see Note 2). Information from biopsy is not used to assign T2. Prostate biopsy information is coded in Site-Specific Factor 14. Codes T2a, T2b, and T2c have precedence over code T2. If the physician assigns cT2 without a subcategory of a, b, or c, use T2. **Note 6:** Assign T2 for localized cancer when it is unknown if the tumor is clinically apparent. This would include cases with elevated PSA and positive needle core biopsy but no documentation regarding tumor apparency (inapparent versus apparent). Another example would be a diagnosis made prior to admission for a prostatectomy with no details provided on the initial clinical findings. **Note 7:** T3 and T4 are used for extension beyond the prostate. Information from biopsy of extraprostatic tissue is assigned in Clinical T. **Note 8:** Involvement of the prostatic urethra does not alter the T code. **Note 9:** "Frozen pelvis" is a clinical term which means tumor extends to pelvic sidewall(s). In the absence of a more detailed statement of involvement, assign a description of frozen pelvis to code T4. **Note 10:** When prostate cancer is an incidental finding during prostatectomy for other reasons: If there is documentation regarding a normal prostate evaluation (physical examination or imaging) prior to prostatectomy/autopsy of an invasive tumor, assign T0 in Clinical T. * If there is no documentation regarding a normal prostate evaluation (physical examination or imaging) prior to prostatectomy/autopsy of an invasive tumor, assign blank in Clinical T **Note 11:** Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is not classified as T3, but as T2.

NAACCR Item

NAACCR #940
Clinical T Clinical T Display Description Registrar Notes
cX cTX Primary tumor cannot be assessed Clinical classification criteria met, evaluation done:
Physician unable to assess T
Extension cannot be determined
Physician assigns cTX, no other information available to determine T
c0 cT0 No evidence of primary tumor
c1 cT1 Clinically inapparent tumor
Neither palpable nor visible by imaging
Note: T1 has subcategories of T1a, T1b and T1c. Assign T1 only when there is no information available to assign one of the subcategories

Incidental histologic finding (for example, on TURP), number of foci or percent of involved tissue not specified (clinically inapparent)
(See Note 4)

Stated as T1 [NOS]
c1A cT1a Tumor incidental histological finding in 5% or less of tissue resected Incidental histologic finding (for example, on TURP) in 5 percent or less of tissue resected (clinically inapparent)
(See Note 4)

Stated as T1a
c1B cT1b Tumor incidental histological finding in more than 5% of tissue resected Incidental histologic finding (for example, on TURP) in more than 5 percent of tissue resected (clinically inapparent)
(See Note 4)

Stated as T1b
c1C cT1c Tumor identified by needle biopsy
e.g., because of elevated prostate-specific antigen (PSA)
Tumor identified by needle biopsy (clinically inapparent)
Example - for elevated PSA
(See Note 4)

Stated as T1c
c2 cT2 Tumor confined within prostate Note: T2 has subcategories of T2a, T2b and T2c. Assign T2 only when there is no information available to assign one of the subcategories

Clinically apparent: do NOT use information from biopsy to determine extent of involvement
(See Note 5)
Involvement in one lobe/side, NOS
Intracapsular involvement only

Clinically apparent tumor confined to prostate, NOS

Confined to prostate but not stated if T1 or T2, clinically inapparent or apparent

Not known if clinically inapparent or apparent

Confined to prostate, NOS
Localized, NOS

Stated as T2 [NOS]
c2A cT2a Tumor involves one-half of one lobe or less Clinically apparent: do NOT use information from biopsy to determine extent of involvement
(See Note 5)

Stated as T2a
c2B cT2b Tumor involves more than one-half of one lobe, but not both lobes Clinically apparent: do NOT use information from biopsy to determine extent of involvement
(See Note 5)

Stated as T2b
c2C cT2c Tumor involves both lobes Clinically apparent: do NOT use information from biopsy to determine extent of involvement
(See Note 5)

Involves both lobes/sides (clinically apparent)

Stated as T2c
c3 cT3 Tumor extends through the prostatic capsule Note: T3 has subcategories of T3a and T3b. Assign T3 only when there is no information available to assign one of the subcategories

Periprostatic extension, NOS (unknown if seminal vesicle(s) involved)
(see Note 11)

Stated as T3 [NOS]
c3A cT3a Extracapsular extension (unilateral or bilateral)
Including microscopic bladder neck involvement
Extracapsular extension (beyond prostatic capsule), NOS
Extension to periprostatic tissue

Through capsule, NOS

Stated as T3a
c3B cT3b Tumor invades seminal vesicle(s) Extension to seminal vesicle(s) plus microscopic bladder neck involvement

Stated as T3b
c4 cT4 Tumor is fixed or invades adjacent structures other than seminal vesicles:
External sphincter
Rectum
Levator muscles
Pelvic wall
Extension to or fixation to adjacent structures other than seminal vesicles:
Bladder neck, except microscopic bladder neck involvement
Bladder, NOS
Fixation, NOS
Rectovesical (Denonvillier's) fascia

Extraprostatic urethra (membranous urethra)

Skeletal muscle, NOS
Ureter(s)

Extension to or fixation to pelvic wall or pelvic bone
"Frozen pelvis", NOS (see Note 9)

Further contiguous extension including:
Bone
Other organs
Penis
Sigmoid colon
Soft tissue other than periprostatic

Stated as T4
88 88 Not applicable Primary site/histology not TNM defined
In situ case but no pTis is defined by TNM
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Clinical classification criteria not met
Clinical classification criteria met, evaluation done:
No information about diagnostic workup
Results not documented in record
Clinical evaluation of primary tumor not done or unknown if done
Tumor first detected on surgical resection (no clinical workup)
Evidence of metastatic disease [(cM1) or (pM1)], no other workup
Only Clinical Stage Group documented (no T, N, or M information available)