Prostate Cancer Staging Form

Tumor Location

Right lobe

Left lobe

Tumor Size

cm

Please enter a number.

Not assessable

Or, check Non-measurable.

Tumor Invasion

Regional Lymph Node

Locations

Obturator

right

left

Internal iliac

right

left

External iliac

right

left

Common iliac

right

left

Sacral

Distant Metastasis

Liver

Adrenal

Lung

Bone

Non-regional lymph node

Others

Scanning Protocol

Prostate

Size

W

mm

H

mm

L

mm

Zonal demarcation

clear

unclear

BPH

s/p TRUS biopsy

s/p TURP