TNM Staging for Prostate Cancer

TNM Prostate Cancer Staging

Tumor

    • Tx: primary tumor cannot be assessed
    • T0: no evidence of a primary tumor
    • T1: clinically in apparent tumor neither palpable not visible by imaging
      • T1a: incidental histology – <5% of resected tissue
      • T1b: incidental histology – >5% of resected tissue
      • T1c: increased PSA and subsequent identification by needle biopsy
    • T2: tumor confined within prostate
      • T2a: half of one lobe or less
      • T2b: greater than half of one lobe, none in other
      • T2c: both lobes
    • T3: tumor extends through capsule
      • T3a: extracapsular extravasion
      • T3b: tumor invades seminal vesicles
    • T4: tumor is fixed or invades adjacent structures other than the seminal vesicles (external sphincter, rectum, bladder, lavator muscles, and/or pelvic wall).

Node

  • Nx: regional lymph nodes not assessed
  • N0: no lymph node metastasis
  • N1: metastasis in regional node(s)

Metastasis

  • M0: no distant metastasis
  • M1a: non-regional lymph node(s)
  • M1b: bone(s)
  • M1c: other sites with or without bone disease
    • When more than 1 site of metastasis is present give advanced stage (M1c) is given

Stress, urge, overflow and mixed incontinence

Urinary incontinence is going when you don’t want to go. It is a big deal because socially it’s just not acceptable and can lead to a lot of psychological stress. If you can’t remember the stages of voiding or the neural control, click here for a refresher.

Types of urinary incontinence

  • Stress: it is caused by an increase in intraabdominal pressure (laughing, coughing, sneezing) and a sphincter that can’t contract enough to prevent leakage
    • Most common type of incontinence in young women
  • Urge: uninhibited contractions of the detrusor muscle, common in older individuals
    • Common in older individuals
  • Mixed: most common type of incontinence, usually refers to a mix of urge and stress incontinence
    • Most common in general
  • Overflow: when the bladder is so full it cannot hold in the urine
    • Common when there’s an obstruction or spinal cord injury

A handy mnemonic to remember the general causes of incontinence is DRIP
Delirium (drugs, acute illness)
Retention (hypocontractility, outflow obstruction)
Inflammation/Infection/Impacted stool
Polyuria (drugs, high output)

Treatment

  • Lifestyle: scheduled voiding, regulating fluid intake, kegel exercises
  • Medications to treat underlying cause (especially anti-cholinergics to treat urge incontinence as the detrusor responds to cholinergic stimulation)
  • Surgery: Such as tension-free vaginal tape (sling) procedure (TVT) for treating stress urinary incontinence
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