Do not add together the size of prostatic chips removed during transurethral resection. If no size is stated, record as 999 in the field "Size of Tumor."
Transurethral resection of the prostate is not adequate surgery to use for AJCC pathologic staging. A complete prostatoseminovesiculectomy must be performed (prostate plus seminal vesicles).
If the seminal vesicles are palpable during rectal examination, assume they are involved by tumor extension from the prostate.
Localized (confined to the gland) prostate cancer includes: foci of carcinoma found by the pathologist on transurethral resection nodule(s) in prostate but prostatic capsule is intact induration of surface of lobe but no extension outside of prostate.
Regional disease includes: extension of tumor outside the prostate and into adjacent organs (bladder, rectum), positive regional lymph nodes, or fixation of the prostate to surrounding structures.
Frozen pelvis is considered distant or metastatic disease.
Extraosseous extension of metastatic prostate cancer is common and should not be considered an additional metastatic site distinct from the area of bone metastases.
The following factors are predictive of capsular penetration, seminal vesicle invasion or regional lymph node involvement and should be considered when assigning stage: elevated serum prostatic acid phosphatase (even high normal range), Gleason pathologic grade.