What is the Crawford and Blumenstein classification system of metastatic and advanced prostate cancer?

Updated: Dec 29, 2020
  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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The definition of stage D by Whitmore-Jewett was further stratified by Crawford and Blumenstein. [6] The additional stratification is thought to improve classification and understanding of a subset of patients who have hormone-insensitive prostate cancer. It is as follows:

  • Stage D1 – Involvement of pelvic lymph nodes
  • Stage D1.5 – Rising prostate-specific antigen (PSA) level after failure of local therapy (ie, biochemical failure)
  • Stage D2 – Metastatic disease to bone and other organs
  • Stage D2.5 – Rising PSA after nadir level
  • Stage D3 – Hormone-refractory prostate cancer
  • Stage D3.5 – Sensitive to hormones
  • Stage D4 – Insensitive to hormones

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