Prostate - CS Tumor Size/Ext Eval

Note 1: THE CODES FOR THIS ITEM FOR PROSTATE DIFFER FROM THE CODES USED FOR MOST OTHER SITES.
Note 2: Since extension detail is coded in both CS Extension - Clinical Extension and CS Site-Specific Factor 3 - Pathologic Extension, the registrar should assign the CS Tumor Size/Ext Eval based on which of these two fields reflects the best information for the case; thus, determining the T category. In general, clinical eval codes (0, 1, 5, and 9) indicate the information from CS Extension - Clinical Extension should be used while pathologic eval codes (3, 4, 6, and 8) indicate the information from CS Site-Specific Factor 3 - Pathologic Extension should be used. The unique eval code 2 indicates information from CS Extension - Clinical Extension should be used but assigns a pathologic (p) staging basis. However, if the assigned eval code is directed to information that is not useful for staging, the algorithm will override this choice and use information from the field most useful for staging. See CS Extension - Clinical Extension Note 8 and the Special Calculation tables for further details.
          If prostatectomy was performed and the information is useful for staging (CS Site-Specific Factor 3 is coded 200-750), assign CS Tumor Size/Ext Eval code 4 or 6.
          If autopsy is performed and the information is useful for staging (CS Site-Specific Factor 3 is coded 200-750), assign CS Tumor Size/Ext Eval code 3 or 8.
          If prostatectomy or autopsy was performed but the information is not useful for staging (CS Site-Specific Factor 3 is coded 950-999), CS Tumor Size/Ext Eval should be assigned based on the information coded in CS Extension - Clinical Extension.
          When CS Extension - Clinical Extension is coded 100-300, 410-750 (invasive) and CS Site-Specific Factor 3 - Pathologic Extension is coded 000 (noninvasive), assign CS Tumor Size/Ext Eval based on information coded in CS Extension - Clinical Extension.
          When CS Extension - Clinical Extension is coded 000, 950, or 999 and CS Site-Specific Factor 3 - Pathologic Extension is coded 000 (noninvasive), assign CS Tumor Size/Ext Eval based on information coded in CS Site-Specific Factor 3 - Pathologic Extension.
Note 3: AJCC allows pathologic staging to be assigned on the basis of some biopsies without resection. According to the AJCC manual, "In general, total prostatoseminal-vesiculectomy, including regional node specimen, and histologic confirmation are required for pathologic T classification". Simple prostatectomy is acceptable for pathologic T classification when disease is confined to the prostate and margins are negative. Under certain circumstances, pathologic T classification can be determined with other means. "For example, (1) positive biopsy of the rectum permits a pT4 classification without prostatoseminal-vesiculectomy, and (2) a biopsy revealing carcinoma in extraprostatic soft tissue permits a pT3 classification, as does a biopsy revealing adenocarcinoma infiltrating the seminal vesicles." For these circumstances, assign CS Tumor Size/Ext Eval code 2 unless prostatectomy/autopsy information coded in CS Site-Specific Factor 3 - Pathologic Extension derives a higher T category.
Note 4: According to AJCC, staging basis for transurethral resection of prostate (TURP) is clinical and is recorded as CS Tumor Size/Ext Eval "1" (c).
Note 5: For CS Extension - Clinical Extension codes 100 -150 without prostatectomy assign CS Tumor Size/Ext Eval code 1 as these extension codes are only proven by TURP or needle core biopsy.
Note 6: For CS Extension - Clinical Extension codes 200 - 240 without prostatectomy assign CS Tumor Size/Ext Eval code 0 as these extension codes are based on physical examination and/or imaging only and NOT biopsy.
Note 7: If the extension (CS Extension - Clinical Extension) prior to neoadjuvant therapy is as extensive or more extensive than the extension at prostatectomy (CS Site-Specific Factor 3 - Pathologic Extension), assign CS Tumor Size/Ext Eval code 5.
Note 8: If the extension (CS Extension - Clinical Extension) prior to neoadjuvant therapy is less extensive than the extension at prostatectomy (CS Site-Specific Factor 3 - Pathologic Extension), assign CS Tumor Size/Ext Eval code 6.

Code	Description	Staging Basis
0	Does not meet criteria for AJCC pathologic staging: No prostatectomy performed or prostatectomy performed but information not useful for staging (see Note 2). Evaluation based on physical examination including digital rectal examination (DRE), imaging examination, or other non-invasive clinical evidence. No autopsy evidence used.	c
1	Does not meet criteria for AJCC pathologic staging: No prostatectomy performed or prostatectomy performed but information not useful for staging (see Note 2). Evaluation based on endoscopic examination, diagnostic biopsy, including needle core biopsy or fine needle aspiration biopsy, transurethral resection (TURP) or other invasive techniques including surgical observation without biopsy. No autopsy evidence used.	c
2	Meets criteria for AJCC pathologic staging: No prostatectomy performed, but positive biopsy of extraprostatic tissue allows assignment to CS Extension codes 410-700 (see Note 3). OR Prostatectomy performed but positive biopsy of extraprostatic tissue derives higher T category (T3/T4 based on CS Extension codes 410-700) than the T category derived from prostatectomy (see Note 3). Not to be used with CS Extension codes 000-300.	p
3	Meets criteria for AJCC pathologic staging: No prostatectomy done, but evidence derived from autopsy (tumor was suspected or diagnosed prior to autopsy).	p
4	Meets criteria for AJCC pathologic staging: Prostatectomy performed WITHOUT pre-surgical systemic treatment or radiation OR Prostatectomy performed, unknown if pre-surgical systemic treatment or radiation performed AND evaluation based on evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery, particularly from pathologic examination of the resected specimen.	p
5	Does not meet criteria for AJCC y-pathologic (yp) staging: Prostatectomy performed AFTER neoadjuvant therapy and tumor size/extension based on clinical evidence (CS Extension - Clinical Extension), unless the pathologic evidence at surgery (AFTER neoadjuvant) is more extensive (see code 6).	c
6	Meets criteria for AJCC y-pathologic (yp) staging: Prostatectomy performed AFTER neoadjuvant therapy and tumor size/extension based on pathologic evidence (CS Site-Specific Factor 3 - Pathologic Extension) because pathologic evidence at surgery is more extensive than clinical evidence before treatment.	yp
8	Meets criteria for autopsy (a) staging: Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy).	a
9	Unknown if prostatectomy done Not assessed; cannot be assessed Unknown if assessed Not documented in patient record	c