Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Epidemiology Table Graphic Jump Location|Download (.pdf)|Print Epidemiology Incidence: 233,000 (Estimated new cases for 2014 in the United States) 152 per 100,000 males per year Stage at Presentation Deaths: Estimated 29,480 in 2014 Stage I: 50% Median age: 66 years Stage II: 20% Stage III: 17% Stage IV: 13% Siegel R et al. CA Cancer J Clin 2014;64:9–29 Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013) ++ Pathology Table Graphic Jump Location|Download (.pdf)|Print Pathology Adenocarcinoma (acinar): >95% Gleason Score at Presentation Ductal adenocarcinoma✫: <1% (Radical prostatectomy specimens) Mucinous✫: <1% 2–4: 6% Small cell✫: <1% 5–6: 54% Transitional cell✫: <1% 7: 30% Small cell✫: <1% 8–9: 10% ✫Poor prognosis Kantoff PW et al. Prostate Cancer: Principles & Practice. Philadelphia: Lippincott ++ Work-up Bone scan if: T1 and PSA >20 T2 and PSA >10 Gleason > or >8 T3/T4 disease Symptomatic Pelvic CT/MRI if: T3/T4 T1/2 and normogram indicates probability of LN invasion >10% ++ Staging Table Graphic Jump Location|Download (.pdf)|Print Staging Primary Tumor (T) Tx Primary tumor cannot be assessed T0 No evidence of primary tumor T1 Clinically inapparent tumor neither palpable nor visible by imaging T1a Tumor incidental histologic finding in 5% or less of tissue resected T1b Tumor incidental histologic finding in more than 5% of tissue resected T1c Tumor identified by needle biopsy (eg, because of elevated PSA) T2 Tumor confined within prostate✫ pT2 Organ confined T2a Tumor involves one-half of 1 lobe or less pT2a Unilateral, one-half of 1 side or less T2b Tumor involves more than one-half of 1 lobe but not both lobes pT2b Unilateral, involving more than one-half of side but not both sides T2c Tumor involves both lobes pT2c Bilateral disease T3 Tumor extends through the prostate capsule† pT3 Extraprostatic extension T3a Extracapsular extension (unilateral or bilateral) pT3a Extraprostatic extension or microscopic invasion of bladder neck‡ T3b Tumor invades seminal vesicle(s) pT3b Seminal vesicle invasion T4 Tumor is fixed or invades adjacent structures other than seminal vesicles: such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall pT4 Invasion of rectum, levator muscles, and/or pelvic wall Note: There is no pathologic T1 classification ✫Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c †Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified not as T3 but as T2 ‡Positive surgical margin should be indicated by an R1 descriptor (residual microscopic disease) Table Graphic Jump Location|Download (.pdf)|Print Staging Staging Groups Group T N M PSA Gleason I T1a–c N0 M0 PSA <10 Gleason ≤6 T2a N0 M0 PSA <10 Gleason ≤6 T1–2a N0 M0 PSA X Gleason X IIA T1a–c N0 M0 PSA <20... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth