Collaborative Stage

Note 1: THE CODES FOR THIS ITEM FOR PROSTATE DIFFER FROM THE CODES USED FOR MOST OTHER SITES.
Note 2: For this site, use this item to evaluate the coding of tumor size and extension as coded in both CS Extension - Clinical Extension AND Site-Specific Factor 3, Pathologic Extension. If prostatectomy was performed and the information is useful for staging assign CS Tumor Size/Ext Eval code 4. If autopsy is performed and the information is useful for staging 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 Tumor Size/Ext Eval should be assigned based on the information coded in CS Extension - Clinical 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."
Note 4: For this site, the T category and its associated c, p, yp, or a indicator are assigned based on the values in CS Extension, CS Tumor Size/Ext Eval, and Site-Specific Factor 3. For details, see CS Extension - Clinical Extension Note 7 and the special calculation extra tables.
Note 5: 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 6: 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 7: 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 8: If the extension (CS Extension - Clinical Extension) prior to neoadjuvant therapy is as extensive or more extensive than the extension at prostatectomy (Site-Specific Factor 3 - Pathologic Extension), assign CS Tumor Size/Ext Eval code 5.
Note 9: If the extension (CS Extension - Clinical Extension) prior to neoadjuvant therapy is less extensive than the extension at prostatectomy (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 done. 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 done. 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 done, but positive biopsy of extraprostatic tissue allows assignment to CS Extension Codes 410-700 (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 (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

Prostate

CS Tumor Size/Ext Eval