Prostate Staging Schemes

American Staging for Prostate Cancer


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


Pathologic staging with some clinical guidelines.


  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


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


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.


  • 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)