CS Site Specific Factor--Prostate: Is there an established range of values that can be used to code negative, borderline or elevated PSA values? See Discussion.
Previous SEER prostate coding guidelines listed a PSA range that could be used to code negative, borderline, or elevated values in the absence of any statement concerning elevated PSA in the medical record. Is this still in effect for SSF 2, or do we need a definite statement when only a numeric value is given?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
This matter is under consideration by the CS Steering Committee. The CS Steering committee is reviewing options for incorporating SEER guidelines into the CS manual.
CS Site Specific Factor--Prostate: How is SSF 6 coded for this site when there is only one Gleason number documented and the number is less than 5 (e.g., Gleasons 3)?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code 999 [unknown or no information]. Note 1 was revised in September 2006 to clarify this situation.
Note 1 states "If only one number is given and it is less than or equal to 5, code the total score to 999, unknown or no
CS Site Specific Factor--Prostate: How are SSF 5 (Gleasons Primary and Secondary Pattern Value) and SSF 6 (Gleasons Score) coded when there is a higher Gleason's pattern in less than 5% of the tumor? See Discussion.
Radical prostatectomy pathology states prostate adenocarcinoma "combined Gleasons score 3+3=6, with a small portion of Gleasons pattern 4 component comprising less than 5% of tumor volume."
The WHO Classification of Tumors of the Urinary System and Male Genital Organs refers to "tertiary" Gleasons patterns in addition to the primary and secondary patterns. On prostatectomy, when this tertiary pattern is 4 or 5, WHO recommends that it should be reported in addition to the Gleasons score even when it is less than 5% of the tumor.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Record Gleason's pattern and score from the largest specimen, even if this is a lower number. Ignore the tertiary pattern for now.
This may change when the AJCC 7th Edition is published, as there is much discussion regarding the tertiary patterns and when they should be utilized. If there is a change in AJCC, at that time there will be a change to CS.
CS Site Specific Factor--Prostate: Given that the CS Manual instruction is to code the highest PSA value recorded in the medical record, can a PSA value obtained a year prior to admission be used to code the SSF 1 and SSF2 fields?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
The PSA recorded in CS SSF 1 and 2 must be documented in the medical record. Record the highest PSA value prior to diagnostic biopsy or treatment. If the highest PSA value documented in the medical record is from the previous year, record it.
CS Site Specific Factor--Prostate: Does perineural invasion affect the coding of SSF3, pathologic extension? See Description.
"Adenoca scattered over a 2.5 cm region bilaterally toward the apex. Perineural invasion is identified, including within the right apex." Does this mean that there is extension into the apex?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.For cases diagnosed 2004 and forward:
Presence or absence of perineural invasion does not affect pathologic extension. Most likely perineural invasion is still localized. It means that there is tumor found along the track of the nerves in the prostate. Where the nerves enter the prostate, the capsule is thinner than in other areas; thus pathologists make note of the potential for extracapsular extension.
The CAP Cancer Protocol for Prostate states that perineural invasion "has been associated with a high risk of extraprostatic extension...although the exact prognostic significance remains to be determined."
Based on the available information, code the case example to 023 [Involves both lobes].
CS Site Specific Factor--Prostate: Are the EOD guidelines developed for coding apex involvement still in effect for determining the code for apical involvement in SSF 4? See Discussion.
How do the old prostate codes 31, 33, and 34 correspond to the new SSF 4 field? Because "arising in" or "extending into" apex is rarely, if ever, stated, previous SEER guidelines instructed us to use code 33 for "apex only" involvement, and code 34 for "apex and any other area of prostate". Code 31 [into/arising, NOS] was to be avoided.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.No, the EOD guidelines for coding apex involvement are not in effect for coding SSF4.
The codes for CS site specific factor 4 include code 2 [into prostatic apex/arising in prostatic apex, NOS]. When it cannot be determined if apical involvement is arising in, or extending to, the apex, use code 2.
CS Site Specific Factor--Melanoma: What is the correct code for measured thickness in SSF 1 for a melanoma of the choroid without an enucleation? See Discussion.
CS Site Specific Factor 1 for melanoma of the choroid codes "Measured Thickness (Depth), Breslow's Measurement." The note for this field states "Record actual measurement in millimeters from the pathology report." For melanoma of the eye, there is often only an eye exam report stating the thickness. Can PE thickness (clinical statement only) be coded for SSF 1 or is this field coded only from pathology? (i.e., all cases treated without enucleation would have this field coded to 999)
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code SSF 1 999 [Unknown] when there is no enucleation, and therefore, no pathology report for a choroid melanoma.
CS Site Specific Factor--Lymphoma: Can the term "intermediate risk" be used to code IPI score? See Discussion.
Patient has Hodgkin disease. The physician states that the patient has bulky stage IIA intermediate risk disease. Is the term "risk" another way of stating IPI score? If so, how would intermediate risk be coded?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown].
CS Site Specific Factor--Lymphoma: Can the registrar calculate the International Prognostic Index (IPI) score from information found in the H&P or on the back of a TNM form for the SSF 3 field if the physician does not document it in the medical record?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Record the IPI score in SSF3 when the score is documented in the medical record. If the score is not stated, do not calculate it.
CS Site Specific Factor--Lymphoma: Can the International Prognostic Index (IPI) score be taken from a TNM form in the record? If so, what score would we code for "low" (0-1 points) and "high" (4-5 points)?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Yes, the IPI score from the TNM form can be used to code SSF 3. Without further information, code "low" as 000 [0 points]. Code "high" as 004 [4 points].
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