ICD Body System
Date amended:
External
Statements of Principles
Current RMA Instruments
Reasonable Hypothesis3 of 2023
Balance of Probabilities4 of 2023
Changes from previous Instruments

Document

ICD Coding
  • ICD-10-AM Code: C61
Brief description

This is a primary cancer of the prostate, a gland in the male reproductive system located just below the bladder.

Confirming the diagnosis

Diagnosis requires confirmation by histology, based on a biopsy or surgery.  Clinical examination, imaging and blood tests may assist but are not definitive. 

The relevant medical specialist is a urologist or oncologist.

Additional diagnoses that are covered by this SOP
  • Adenocarcinoma of the prostate
  • Adenocarcinoma of the prostate with focal neuroendocrine differentiation
  • Adenoid cystic/basal cell carcinoma of the prostate
  • Adenosquamous carcinoma of the prostate
  • High grade prostatic intraepithelial neoplasia
  • Squamous cell carcinoma of the prostate
  • Treatment-related neuroendocrine prostatic carcinoma
Conditions that are excluded from this SOP
  • Benign prostatic hypertrophy*/hyperplasia
  • (Pure) Carcinoid of the prostate# (a primary neuroendocrine tumour)
  • Cystadenoma of the prostate#
  • Germ cell tumour of the prostate#
  • Nephroblastoma of the prostate#
  • Neuroblastoma of the prostate#
  • Non-Hodgkin lymphoma of the prostate*
  • Large cell neuroendocrine carcinoma# (a primary neuroendocrine tumour)
  • Low grade prostatic intraepithelial neoplasia#
  • Paraganglionoma of the prostate#
  • Primary neuroendocrine tumour of the prostate# 
  • Rhabdoid tumour of the prostate#
  • Secondary/metastatic cancer involving the prostate (code to primary cancer site)
  • Small cell neuroendocrine carcinoma# (a primary neuroendocrine tumour)
  • Soft tissue sarcoma of the prostate*

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will typically coincide with date of diagnosis or date of provisional diagnosis (subsequently confirmed) based on clinical examination. The condition typically presents in older men and is rare below the age of 50.  The presence of prior urinary symptoms will generally not provide a basis for establishing a clinical onset, as a range of other conditions could be responsible.  Prostatic-specific antigen level is not a reliable indicator of prostate cancer - an elevated level in most cases does not provide a basis for establishing a clinical onset. 

Clinical worsening

Prostate cancer has a very variable course and prognosis.  Establishing whether worsening beyond the normal course of the disease has occurred will generally require expert medical opinion.