TNM classification of prostate cancer.
| T | Tumor |
| TX | Primary tumor not assessable |
| T0 | No evidence of primary tumor |
| T1 | Tumor neither palpable nor visible in imaging techniques |
| T1a | Incidental finding at TUR-P (transurethral resection of the prostate/surgical removal of the prostate through the urethra), ≤ 5% of resected tissue |
| T1b | Incidental finding at TUR-P, >5% of resected tissue. |
| T1c | Diagnosis by prostate punch biopsy (tissue removal from the prostate). |
| T2 | Tumor confined to the prostate |
| T2a | Involvement of half of a prostatic lobe or less |
| T2b | Involvement of more than half of a prostatic lobe |
| T2c | Involvement of both prostatic lobes |
| T3 | Tumor exceeds the prostate capsule |
| T3a | Extracapsular (outside the capsule) spread, unilateral |
| T3b | Extracapsular spread, bilateral |
| T3c | Tumor invasion of one or both seminal vesicles |
| T4 | Tumor is fixed or infiltrating adjacent structures |
| T4a | Tumor invasion of bladder neck and/or external sphincter (sphincter) and/or rectum(rectum) |
| T4b | Tumor invasion of the pelvic floor and/or tumor fixed to the pelvic wall |
| N | Nodus (lymph node) |
| NX | Lymph node not assessable |
| N0 | No lymph node metastases (daughter tumors in the lymph nodes) |
| N1 | Lymph node metastases in a regional lymph node with a largest diameter not exceeding 2 cm |
| N2 | Lymph node metastases in one or more regional lymph nodes with a largest diameter greater than 2 cm but less than 5 cm |
| N3 | Regional lymph node metastases greater than 5 cm in diameter |
| M | Metastases (daughter tumors) |
| MX | Distant metastases not assessable |
| M0 | No distant metastases |
| M1 | Distant metastases |
| M1a | Non-regional lymph nodes |
| M1b | Bone metastases |
| M1c | Other localization |
Clinical manifestation forms
- Incidental prostate carcinoma: normal rectal palpation findings (palpation findings), discovered histologically (demonstrated by fine tissue) after surgery for benign prostatic syndrome (BPS) during TUR-P.
- Manifest prostate carcinoma: rectally palpable tumor, independent of symptoms.
- Occult prostate cancer: initial manifestation of the tumor in metastatic settlements without evidence of the primary tumor.
- Latent prostate cancer: clinically inapparent ( “not appearing”), diagnosis by autopsy (examination of the human body after death to determine the cause of death).
Histological classification
- Adenocarcinomas (95% of all tumors).
- Mucinous carcinomas
- Papillary ductal carcinomas
- Adenoid-cystic carcinomas
- Endocrine-differentiated carcinomas
- De-differentiated carcinomas
Classification under therapeutic aspects
In terms of therapy, we distinguish:
- Incidental carcinomas found during transurethral resection of the prostate and found in less than 5% of resection chips (T1a tumors).
- Localized tumors (T1b – T2b, N0, M0).
- Locally advanced tumors (T3, N0, M0).
- Metastatic tumors (Tx, N1, M0/1)
- Hormone refractory tumors (= prostate cancers in progression (progressing) under antiandrogen therapy/drugs that inhibit the action of male sex hormones).
Determination of the risk of progression in localized prostate carcinoma
Determination based on the indicators PSA level and Gleason score:
| Risk | Conditions |
| Low risk | PSA ≤ 10 ng/ml and Gleason score 6 and cT category 1c, 2a. |
| Intermediate risk | PSA > 10-20 ng/ml or Gleason score 7 or cT category. |
| High risk | PSA > 20 ng/ml or Gleason score ≥ 8 or cT category 2c. |
Whitmore-Jewett Stadium
| Stage | Description | Analogous TNM stage |
| A 1 | Well differentiated tumor | T 1a |
| A 2 | More diffuse participation | T 1b |
| BIN | Palpable, <1 lobe, surrounded by normal tissue. | T 2a |
| B 1 | Palpable, <1 lobe | T 2b |
| B 2 | Palpable, one whole lobe or both lobes | T 2c |
| C 1 | Palpable, outside the capsule, not in seminal vesicles | T 3a |
| C 2 | Palpable, seminal vesicles involved | T 3c |
| D | Metastases | M 1 |
Gleason score
Gleason score is used for histological (fine tissue) assessment or grading of prostate cancer. It assesses the so-called degree of dedifferentiation (deviations in glandular pattern and cell nuclei) of the most common and the second most common cell population of the tumor. For this purpose, values from 1 to 5 are assigned in each case. The higher the value, the higher the degree of dedifferentiation.The Gleason score is always given according to the following pattern: Gleason value 1 + Gleason value 2 = sum of both valuesIn addition to the TNM classification and the PSA value, the Gleason score is the most important prognostic factor of prostate cancer. The Gleason score represents the following degrees of differentiation or grading:
| Gleason score | Level of differentiation |
| 2-4 | well differentiated tumor |
| 5-6 | moderately differentiated tumor |
| 7 | Intermediate to poorly differentiated tumor |
| 8-10 | poorly to de-differentiated tumor |
Tumors with a Gleason score of 2 to 4 are usually discovered incidentally during prostate surgery (e.g., during a transurethral resection (TUR)/surgical technique in which diseased tissue is removed from the urinary bladder or prostate, in this case: Peeling of the prostate due to BPH, i.e. benign prostatic hypertrophy/ benign prostatic enlargement). Most tumors found during a punch biopsy (puncture to obtain a cylinder of tissue from the prostate) have a score of 6 or 7. Tumors with a score of 8 to 10 are often fast-growing aggressive tumors that are more often already progressive (advanced) at the time of diagnosis. Physicians at Johns Hopkins Hospital proposed a new Gleason score risk classification (Glaeson grading) in 2013, which was endorsed by the International Society of Urological Pathology (ISUP) in 2014 and accepted by the WHO:
| Glaeson grading | Glaeson score | Five-year survival, without biochemical recurrence (Gleason groups determined by biopsy). | Five-year survival, without biochemical recurrence (prostatectomy specimen). |
| 1 | ≤ 6 | 94,2 % | 91,1 % |
| 2 | 3 + 4 | 89,2 % | 93,0 % |
| 3 | 4 + 3 | 73,1 % | 74,0 % |
| 4 | 8 | 63,1 % | 64,4 % |
| 5 | 9-10 | 54,7 % | 49,9 % |
Note: Upgrading of low-grade tumors after a second biopsy (tissue removal) or prostatectomy (prostate removal) does not necessarily indicate a worse prognosis.
TNM classification of prostate cancer after radical prostatectomy (pathological stage)
| Stage | Description |
| pT2 | Tumor confined to the prostate |
| pT2a | Tumor affects <50% of a lateral lobe |
| pT2b | Tumor affects >50% of a lateral lobe |
| pT2c | Tumor affects both lateral lobes |
| pT3a | Infiltration of the periprostatic adipose tissue |
| pT3b | Infiltration of one or both seminal vesicles |
| pT4 | Infiltration of adjacent organs |
| pN0 | No metastases in the regional lymph nodes |
| pN1 | Metastases in the regional lymph nodes |
