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Table 4. Definitions of TNM Stage IV

Stage TNM Description 
IVT4, N0, M0, any GT4 = Tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.a
GX = Grade cannot be assessed.
G1 = Well differentiated (slight anaplasia) (Gleason score of 2–4).
G2 = Moderately differentiated (moderate anaplasia) (Gleason score of 5–6).
G3–4 = Poorly differentiated or undifferentiated (marked anaplasia) (Gleason score of 7–10).
Any T, N1, M0, any GTX = Primary tumor cannot be assessed.
T0 = No evidence of primary tumor.
T1 = Clinically inapparent tumor not palpable or visible by imaging.
T1a = Tumor incidental histologic finding in ≤5% of tissue resected.
T1b = Tumor incidental histologic finding in >5% of tissue resected.
T1c = Tumor identified by needle biopsy (e.g., because of elevated PSA).
T2 = Tumor confined within prostate.b
T2a = Tumor involves ≤50% of one lobe.
T2b = Tumor involves >50% of one lobe but not both lobes.
T2c = Tumor involves both lobes.
T3 = Tumor extends through the prostate capsule.c
T3a = Extracapsular extension (unilateral or bilateral).
T3b = Tumor invades seminal vesicle(s).
T4 = Tumor is fixed or invades adjacent structures other than seminal vesicles such as the bladder, external sphincter, rectum, levator muscles, and/or pelvic wall.
N1 = Metastasis in regional lymph node(s).
M0 = No distant metastasis.a
GX = Grade cannot be assessed.
G1 = Well differentiated (slight anaplasia) (Gleason score of 2–4).
G2 = Moderately differentiated (moderate anaplasia) (Gleason score of 5–6).
G3–4 = Poorly differentiated or undifferentiated (marked anaplasia) (Gleason score of 7–10).
Any T, any N, M1, any GTX = Primary tumor cannot be assessed.
T0 = No evidence of primary tumor.
T1 = Clinically inapparent tumor not palpable or visible by imaging.
T1a = Tumor incidental histologic finding in ≤5% of tissue resected.
T1b = Tumor incidental histologic finding in >5% of tissue resected.
T1c = Tumor identified by needle biopsy (e.g., because of elevated PSA).
T2 = Tumor confined within prostate.c
T2a = Tumor involves ≤50% of one lobe.
T2b = Tumor involves >50% of one lobe but not both lobes.
T2c = Tumor involves both lobes.
T3 = Tumor extends through the prostate capsule.c
T3a = Extracapsular extension (unilateral or bilateral).
T3b = Tumor invades seminal vesicle(s).
T4 = Tumor is fixed or invades adjacent structures other than seminal vesicles such as the bladder, external sphincter, rectum, levator muscles, and/or pelvic wall.
NX = Regional lymph nodes were not assessed.
pNX = Regional nodes not sampled.
N0 = No regional lymph node metastasis.
pN0 = No positive regional nodes.
N1 = Metastasis in regional lymph node(s).
pN1 = Metastases in regional node(s).
M1 = Distant metastasis.a
M1a = Nonregional lymph node(s).
M1b = Bone(s).
M1c = Other site(s) with or without bone disease.
GX = Grade cannot be assessed.
G1 = Well differentiated (slight anaplasia) (Gleason score of 2–4).
G2 = Moderately differentiated (moderate anaplasia) (Gleason score of 5–6).
G3–4 = Poorly differentiated or undifferentiated (marked anaplasia) (Gleason score of 7–10).

T = Primary tumor; N = Regional lymph nodes; M = Distant metastasis; G = Histopathologic grade; p = Pathologic.
Reprinted with permission from AJCC: Prostate. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 457-68.
aWhen more than one site of metastasis is present, the most advanced category (pM1c) is used.
bTumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c.
cInvasion into the prostatic apex or into (but not beyond) the prostatic capsule is classified not as T3 but as T2.