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SEER Inquiry System - Report
Produced: 03/16/2026 9:52 PM
Question 20260009
Inquiry Details
References:
#1: 2026 SEER Manual, 97-99. Date of Diagnosis; Appendix E
#2: 2026 STORE Manual, 12. Case Eligibility
Question:
SEER Manual/Reportability/Date of Diagnosis--Prostate: How is the diagnosis date coded when a Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesion is identified on imaging, but further work-up or biopsy does not follow for 6 months or more? See Discussion.
Discussion:
PI-RADS 4 and 5 are reportable per the SEER Manual and can be used to code the diagnosis date. When further work-up does not shortly follow the MRI, and no information is available to the central registry to account for the delay, should the date of the biopsy be used to code diagnosis date?
The PI-RADS 4/5 statement is an ambiguous terminology diagnosis, and this is a reference of last report. Is there a time cut-off registry should consider when there is a months-long delay and no info available to account for the biopsy delay? Using the PI-RADS diagnosis in these cases makes it appear as if any first course treatment is often greater than 1 year after "diagnosis," when it is really only approximately 6 months after the biopsy.
Which source should be used to code diagnosis date in these cases?:
Case 1: 01/04/2023 MRI identified both PI-RADS 4 and 5 lesions bilaterally. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 05/20/2024 biopsy proved adenocarcinoma. The patient underwent a prostatectomy approximately 6 months after biopsy on 01/13/2025. Biopsy diagnosis followed MRI diagnosis more than 16 months later and the plan was for active treatment.
Case 2: 02/05/2024 MRI identified a PI-RADS 5 lesion. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 08/29/2024 biopsy proved adenocarcinoma. After consultation with the urologist, active surveillance was recommended on 01/27/2025. Biopsy diagnosis followed MRI diagnosis more than 6 months later and the plan was for active surveillance.
Answer:
We recognize that there are differences between the SEER and STORE manuals regarding reportability and date of diagnosis (see SINQ 20260007) for RADS. We will be consulting with the Commission on Cancer Quality Assurance and Data Committee to reach a decision regarding the differences.
For continuity in comparing trends in treatment over time, follow the current guidance for SEER. Once the group has decided, we will update the guidance accordingly for the 2027 release of the SEER Manual at the earliest.
