TNM Staging for Prostate Cancer

TNM Prostate Cancer Staging


    • 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).


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


  • 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

Storage vs voiding symptoms of prostatism

Prostatism – urinary symptoms caused by the prostate

**IMPORTANT prostatism symptoms are not necessarily caused by an “enlarged” prostate because it’s not the absolute size of the prostate that causes symptoms, it’s how much the prostate is interfering with the flow of urine.

Useful to divide symptoms into storage and voiding.


  • Frequency
  • Urgency
  • Nocturia


  • Hesitancy
  • Poor flow
  • Intermittent flow
  • Straining
  • Incomplete emptying

Symptoms can be graded using the International Prostate Symptom Score (IPSS) which rates emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia on scales of 0 – 5. You then add the scores together to get a score out of 35.
0-7 Mildly symptomatic
8-19 Moderately symptomatic
20-35 Severely symptomatic

Causes of hyponatremia

First – look to see what the person’s sodium is
Second – what is their volume status

The most important thing about hyponatremia is don’t correct more than 8 to 12 mmol/L per day!!!

Also, the paper titled “The Syndrome of Inappropriate Antidiuresis” by Ellison and Berl (N Engl J Med 2007;356:2064-72) is very useful.