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Prostate Staging Schemes

American Staging for Prostate Cancer

History:

American or AUS (American Urologic System) Staging has been translated to TNM extent of disease notation by the American Joint Committee.

Criteria:

Pathologic staging with some clinical guidelines.

Categories:

  1. Stage A can be subdivided based on the number of cell clusters (foci) seen on microscopic examination.
  2. The difference between Stage A and Stage B is whether nodule(s) are clinically palpable (or visibly seen) in prostate.
  3. Dividing line between Stage B and Stage C is capsular invasion microscopically.
  4. Stage D is metastatic disease identified either clinically or microscopically.

In AJCC staging, lymph nodes in N notation range from single homolateral to fixed regional and distant. These are all equivalent to Stage D disease.

Guidelines for American Staging for Prostate:

  • Stages A1, B1, C1, D1 correspond to T1, T2, T3, T4.
  • Stages A and B are localized, Stage C regionalized, Stage D distant.

Gleason's Score/system for Grading of Prostate Cancer

History:

First proposed in 1966 by Donald F. Gleason, a pathologist at the University of Minnesota in Minneapolis, MN.

Criteria:

A pathologic classification only. Based on the premise that poorly-differentiated tumors are more aggressive and unpredictable than well-differentiated tumors. Gleason's score is not a staging system.

Method:

  • Pathologist reviews specimen microscopically and observes whether the malignant cells are similar in structure to the tissue of origin. The closer to the original tissue, the better differentiated.
  • Pathologist looks for a primary predominant pattern for cells, and a secondary or lesser pattern. Each is given a score from 1 to 5.
  • Scores for primary and secondary patterns are added together to achieve the Gleason score for the tumor. Scores can range from 2 (uniformly well differentiated 1 + 1) to 10 (diffusely anaplastic 5 + 5)