Current RMA Instruments:

Changes from previous Instruments:

SOP Bulletin194.pdf

ICD Coding:

• ICD-9-CM Codes: 185
• ICD-10-AM Codes: 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
• Carcinoma of the prostate

Conditions that are excluded from this SOP

• Benign prostatic hypertrophy*/hyperplasia
• Carcinoid of the prostate ^#
• Non-Hodgkin's lymphoma of the prostate*
• Prostatic intraepithelial neoplasia (PIN) ^#
• Secondary/metastatic cancer involving the prostate (code to primary cancer site)
• Soft tissue sarcoma of the prostate*

* another SOP applies  - the SOP has the same name unless otherwise specified

^# 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 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.