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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Cancer staging

TNM scores

TNM scores

The AJCC (






ommittee on



staging system is used to stage prostate cancer.

In this system, the letters T, N, and M describe a

different location of cancer growth. Your doctors will

assign a score to each letter. These scores will be

combined to assign a cancer stage.

TNM scores are very important for treatment planning.

NCCN experts decide options for initial treatment

partly based on these scores. See Part 5.

T = Tumor

The T score is a rating of the size and extent of the

primary tumor. T1 tumors can’t be felt or seen with

imaging tests. They are found in tissue removed by

biopsies or surgical treatment. For example, prostate

cancer may be found in men who had an abnormal

PSA level or who had an operation for urinary

problems caused by an enlarged prostate. Prostate

cancer discovered as a result of an operation for

voiding problems is called an incidental finding.


means that incidental cancer was found in

5% or less of the removed tissue.


means that incidental cancer was found

in more than 5% of the removed tissue.


tumors are found by needle biopsy that

was done for a high PSA level.

T2 tumors can be felt by your doctor during a

DRE. They also may be seen with an imaging test.

T2 scores are based on cancer growth within the

lobes—the left and right halves of the prostate.

T2 tumors haven’t grown outside the prostate gland.

• T2a

tumors haven’t grown beyond half of one


• T2b

tumors have grown beyond half of one

lobe but not to the other lobe.

• T2c

tumors have grown into both lobes.

T3 tumors have grown outside the prostate. They

have reached the connective tissue around the

prostate, the seminal vesicles, or the neck of the


See Figure 6


• T3a

tumors have grown outside the prostate

but not into the seminal vesicle(s).

• T3b

tumors have grown outside the prostate

and into the seminal vesicle(s).

T4 tumors are fixed to or have invaded other nearby

tissues. Such tissues include the external sphincter,

rectum, bladder, levator muscles, and pelvic wall.

• T4

tumors are fixed to or have grown into

nearby tissues other than seminal vesicles.

N = Nodes

Lymph drains from around prostate cells into vessels

that transport it to the bloodstream. As lymph travels,

it passes through small, oval-shaped structures

called lymph nodes. Lymph nodes remove germs

from lymph. As shown in

Figure 7

, lymph nodes and

vessels are found throughout the body.

The N category reflects if cancer cells have spread

through lymph to nearby lymph nodes. Nearby lymph

nodes include the hypogastric, obturator, internal and

external iliac, and sacral lymph nodes. Most often,

prostate cancer spreads to the external iliac, internal

iliac, or obturator nodes. N scores for prostate cancer



means it is unknown if there is cancer in

lymph nodes.

• N0

means that there is no cancer within the

nearby lymph nodes.


means that the cancer has spread into the

nearby lymph nodes.