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Report Produced: 10/07/2026 17:14 PM

Report Question ID Question Discussion Answer Cancer Site Category Data Item Category Year
20000428 EOD-Clinical Extension--Prostate: How do you distinguish between clinical extension codes of 10, 13, 14, and 20 for cases with a benign prostate per digital rectal exam that appear localized after TURP/prostatectomy? Can the clinical extension code of 10 be used if the term "microscopic carcinoma" is noted in the pathology report without also mentioning "foci" or "Stage A" for clinically inapparent tumors?

For cases diagnosed 1998-2003:

When the prostate feels benign and the cancer is found incidentally at the time of the microscopic exam, code the EOD-Extension field to 10 [number of foci or % of involved tissue not specified]. Code as 13 (less than or equal to 5%) or 14 (greater than 5%) if percentage involved is given in the tissue resected. If the path report states "solitary focus of carcinoma" without mentioning the total amount of tissue resected, code extension to 13. If there is more than one focus, code extension to 10. Don't assign a code of 20 unless the tumor is clinically apparent.

 Prostate N/A 2000
20260009

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 and therefore reportable, but further work-up or biopsy does not follow for 6 months or more? See Discussion.

2026 SEER Manual Appendix E states PI-RADS (4 and 5) are reportable; they can be used to code the diagnosis date.

The Date of Diagnosis Coding Instruction 3 in the SEER Manual states:The first diagnosis of cancer may be clinical (i.e., based on clinical findings or physician’s documentation) Note: Do not change the date of diagnosis when a clinical diagnosis is subsequently confirmed by positive histology or cytology.

2026 STORE Manual states:

PI-RADS, BI-RADS, LI-RADs alone are not reportable for CoC. PI-RADS, BI-RADS, L-RADS confirmed with biopsy or physician statement are reportable to CoC. Date of diagnosis is the date of the positive biopsy or definitive statement from physician.

Example: 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.

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?

Using the SEER 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.

Updated June 2026

Report PI-RADS 4 or 5 PI-RADS only when confirmed with biopsy or when based on a recognized medical practitioner statement. Use the date of diagnosis as the date of the positive biopsy or the definitive statement from the recognized medical practitioner, whichever is earlier.

Use the date of biopsy in the two case scenarios based on the revised guidance.

We will include this update in the next release of the SEER Manual.

 Prostate Date of diagnosis 2026
20160077

First course treatment/Immunotherapy--Prostate:  Is XGEVA, given for bone mets from prostate cancer, abstracted as immunotherapy, or is it an ancillary drug and not recorded?

Do not record XGEVA when given for bone mets from prostate cancer.  See SEER*Rx for more information.

 

 

Prostate First course treatment, Immunotherapy 2016
20000516 Diagnostic Confirmation--Prostate: How do we code this field when there is an elevated PSA, no other work-up and there is a clinical diagnosis of adenocarcinoma? Code the Diagnostic Confirmation field to 5 [positive laboratory test/marker study] to indicate the diagnosis is based upon an abnormal PSA tumor marker if the physician uses the PSA as a basis for diagnosing prostate cancer. Prostate Diagnostic confirmation 2000
20100032 First course treatment--Prostate: Is Degarelix coded as hormonal treatment for prostate cancer? Code the administration of Degarelix in the "Hormone Therapy" field. Assign code 01 [Hormone therapy administered as first course therapy]. This drug will be added to the next update of SEER*Rx. Prostate First course treatment 2010
20091103 Reportability/Ambiguous Terminology--Prostate: Is a prostate biopsy that states "highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy" reportable? Do not report. "Not diagnostic of" means that while the pathologist is seeing some features that resemble cancer, there are not enough features to feel comfortable making an unquestionable diagnosis. Watch for another biopsy of the patient in the next 3-6 months. The statement "not diagnostic of" overrules the "highly suspicious" statement. Prostate N/A 2009
20240017

EOD 2018/Prostate Pathologic Extension--Prostate: Is a pathology report from a prostate biopsy/transurethral resection of the prostate that states "with intraductal spread" extraprostatic/extracapsular extension or localized?

Code as a localized, intracapsular tumor as ductal carcinoma in situ does not invade. Intraductal spread is describing the neoplasm spreading through the acinar/ductal cells in the prostate specimen. It is an in-situ type of spread and not invasive but almost always presents with an invasive tumor.

 Prostate EOD Primary Tumor 2024
20190030

Summary Stage 2018/Extension--Prostate: Can imaging be used to code SEER Summary Stage 2018? MRI shows tumor involved the seminal vesicles and the patient did not have surgery. AJCC does not use imaging to clinically TNM stage a prostate case.

Note 5 was changed in Version 2.0.

Per Note 5 of the 2018 SEER Summary Stage Prostate chapter: Imaging is not used to determine the clinical extension. If a physician incorporates imaging findings into their evaluation (including the clinical T category), do not use this information.

This note was changed in Version 2.0 (2021 changes) to be in line with how AJCC stages; therefore, AJCC and Summary Stage agree.

 Prostate N/A 2019
20041011 EOD-Clinical Extension--Prostate: Should this field be coded to 15 [Tumor identified by needle biopsy for elevated PSA] or 30 [Localized, NOS] when the only information is from a biopsy positive pathology report that includes the clinical history of "PSA elevated, DRE negative," with no mention of an ultrasound being performed?

For cases diagnosed 1998-2003: For this scenario, assign code 15 if an ultrasound was not performed, performed and negative, or when it is unknown whether or not an ultrasound was performed. Assign code 30 only if an ultrasound was performed and there is no documentation stating that it was negative or positive.

Please refer to the Prostate EOD Coding Guidelines for all of the instructions pertaining to the coding of prostate EOD.

 Prostate N/A 2004
20210054

EOD 2018/EOD Primary Tumor/Tumor Size--Clinical--Prostate: How is Tumor Size--Clinical coded when there is an incidental finding of prostate cancer on prostatectomy for another reason? See Discussion.

SEER*RSA states EOD Primary Tumor should be coded to 800 for an incidental finding of prostate cancer on prostatectomy for other reasons.

The SEER Manual states to assign code 000 for Tumor Size--Clinical when EOD Primary Tumor is coded to 800; however, the definition for Tumor Size--Clinical indicates clinical classification is composed only of diagnostic workup prior to treatment.

If there is no clinical workup for an incidental finding of prostate cancer, code 000 does not seem appropriate (does not meet criteria for clinical classification). Code 999 seems more appropriate for incidental findings during surgery for other reasons. The SEER Manual does not provide this exception in the current instruction.

Assign code 000 for Tumor Size--Clinical when EOD Primary Tumor is coded 800 (No evidence of primary tumor). Code 000 indicates no tumor was found since there was no clinical workup to identify this incidentally found cancer. This is a special instruction for cases coded 800 in EOD Primary Tumor. Text fields can be used to record details.

 Prostate EOD Primary Tumor, Tumor size 2021