Prostate Cancer Specification - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Semantic Annotations
This page lists all Observation.code elements used across the scenarios along with their value types and possible answers. For coded answers (valueCodeableConcept), the known codes are listed in separate tables below.
Abbreviations: CNB = Core Needle Biopsy, RP = Radical Prostatectomy, TUR = Transurethral Resection, ENUC = Transurethral Enucleation
Diagnoses and Differential Diagnoses
Malignant Diagnoses
| Diagnosis |
ICD-O-3 |
SCT Disorder |
SCT Morphology |
| Acinar adenocarcinoma |
8140/3 |
399490008 |
1187332001 |
| Ductal adenocarcinoma |
8500/3 |
823017009 |
82711006 |
| Intraductal carcinoma (IDC-P) |
8500/2 |
— |
1162814007 |
| Invasive cribriform carcinoma (ICC) |
8201/3 |
— |
30156004 |
| Small cell carcinoma |
8041/3 |
1208457007 |
74364000 |
| Squamous cell carcinoma |
8070/3 |
399590005 |
1162767002 |
| Urothelial carcinoma |
8120/3 |
— |
27090000 |
Notes:
- SCT Disorder = prostate-specific SNOMED CT concept (Site+Morphology), SCT Morphology = morphology only
- IDC-P, ICC, urothelial carcinoma: no prostate-specific disorder code in SCT INT; post-coordination may be required
- Acinar adenocarcinoma: alternatively
1259672003 (Primary adenocarcinoma of prostate)
- Squamous cell carcinoma:
1162767002 is the active replacement for inactive 28899001
Pre-malignant / Borderline Entities
| Entity |
ICD-O-3 |
SNOMED CT |
| High-grade prostatic intraepithelial neoplasia (HGPIN) |
8148/2 |
SCT 446711009 |
| Atypical small acinar proliferation (ASAP) |
— |
SCT 16294321000119104 |
Benign Diagnoses
| Diagnosis |
ICD-O-3 |
SNOMED CT |
| Benign prostatic hyperplasia (BPH) |
— |
SCT 266569009 |
| Chronic prostatitis |
— |
SCT 19905009 |
| Granulomatous prostatitis |
— |
SCT 61500009 |
Macroscopy
| Observation.code |
Display |
value[x] |
Value Domain |
Scenario |
| LOINC 44619-5 |
Length of tissue core(s) |
valueQuantity |
cm |
CNB |
| LOINC 44652-6 |
Total number of cores in Tissue core |
valueQuantity |
{count} |
CNB |
| LOINC 20228-3 |
Anatomic part Laterality |
valueCodeableConcept |
→ VS Laterality |
CNB, RP |
| LOINC 29638-4 |
Weight of Tissue |
valueQuantity |
g |
RP, TUR, ENUC |
| LOINC 84894-5 |
Dimension [Length] of Specimen |
valueQuantity |
cm |
RP, TUR, ENUC |
| SCT 395557000 |
Tumor finding |
valueCodeableConcept |
→ VS Present/Absent |
RP |
| LOINC 84895-2 |
Seminal vesicles [Presence] in Specimen |
valueCodeableConcept |
→ VS Present/Absent |
RP |
Microscopy – Histology & Grading
| Observation.code |
Display |
value[x] |
Value Domain |
Scenario |
| LOINC 59847-4 |
Histology and Behavior ICD-O-3 Cancer |
valueCodeableConcept |
→ VS ICD-O-3 Morphology |
All |
| LOINC 33731-1 |
Histology type in Cancer specimen Narrative |
valueString |
Free text |
All |
| LOINC 44641-9 |
Gleason pattern.primary in Prostate tumor |
valueCodeableConcept |
→ VS Gleason Pattern |
All |
| LOINC 44642-7 |
Gleason pattern.secondary in Prostate tumor |
valueCodeableConcept |
→ VS Gleason Pattern |
All |
| LOINC 35266-6 |
Gleason score in Specimen Qualitative |
valueCodeableConcept |
→ VS Gleason Score |
All |
| LOINC 94735-8 |
Prostate tumor area with Gleason pattern 4+5 [Area Fraction] |
valueQuantity |
% |
All |
| SCT 1812491000004107 |
Histologic grade by ISUP technique |
valueCodeableConcept |
→ VS ISUP Grade Group |
All |
| LOINC 21858-6 |
Grade Cancer |
valueCodeableConcept |
→ VS WHO Differentiation Grade |
All |
Microscopy – Tumor Extent per Core
| Observation.code |
Display |
value[x] |
Value Domain |
Scenario |
| LOINC 44618-7 |
Total linear mm of carcinoma |
valueQuantity |
mm |
CNB |
| LOINC 44654-2 |
Tissue involved by tumor in Prostate tumor |
valueQuantity |
% |
CNB, RP, TUR, ENUC |
| LOINC 92837-4 |
Perineural invasion [Presence] in Cancer specimen |
valueCodeableConcept |
→ VS Present/Not seen |
All |
| SCT 1162814007 |
Non-infiltrating intraductal carcinoma |
valueCodeableConcept |
→ VS Present/Not seen |
All |
| LOINC 94666-5 |
High grade prostatic intraepithelial neoplasia [Presence] |
valueCodeableConcept |
→ VS Present/Not seen |
All |
| LOINC 94667-3 |
Atypical small acinar proliferation [Presence] |
valueCodeableConcept |
→ VS Yes/No |
CNB |
| LOINC 94665-7 |
Granulomatous prostatitis [Presence] |
valueCodeableConcept |
→ VS Present/Not seen |
All |
Diagnostic Conclusion – Invasions
| Observation.code |
Display |
value[x] |
Value Domain |
Scenario |
| LOINC 44625-2 |
Periprostatic fat invasion |
valueCodeableConcept |
→ VS Present/Not seen |
All |
| LOINC 84902-6 |
Extraprostatic extension site [Anatomy] |
valueCodeableConcept |
→ VS EPE Location |
CNB, RP |
| LOINC 44626-0 |
Seminal vesicle invasion |
valueCodeableConcept |
→ VS Present/Not seen |
All |
| LOINC 33761-8 |
Venous + Lymphatic small vessel invasion |
valueCodeableConcept |
→ VS Present/Not seen |
All |
| LOINC 84906-7 |
Bladder neck involvement of Prostate tumor |
valueCodeableConcept |
→ VS Present/Not seen |
RP |
| SCT 30156004 |
Cribriform carcinoma (invasive) |
valueCodeableConcept |
→ VS Present/Not seen |
RP |
Diagnostic Conclusion – Tumor Quantification
| Observation.code |
Display |
value[x] |
Value Domain |
Scenario |
| LOINC 44651-8 |
Tissue cores.positive.carcinoma in Tissue core |
valueQuantity |
{count} |
CNB |
| SCT 372303007 |
Ratio of blocks with prostate tumor to total |
valueRatio |
Ratio |
CNB |
| LOINC 44618-7 |
Total linear mm of carcinoma |
valueQuantity |
mm |
CNB |
| LOINC 33728-7 |
Size.maximum dimension in Tumor |
valueQuantity |
mm |
RP |
| LOINC 44654-2 |
Tissue involved by tumor in Prostate tumor |
valueQuantity |
% |
RP, TUR, ENUC |
Diagnostic Conclusion – Resection Margins (RP only)
| Observation.code |
Display |
value[x] |
Value Domain |
| LOINC 84905-9 |
Margin involvement [Type] in Prostate tumor |
valueCodeableConcept |
→ VS Margin Status |
Diagnostic Conclusion – Lymph Nodes (RP only)
| Observation.code |
Display |
value[x] |
Value Domain |
| LOINC 21894-1 |
Regional lymph nodes examined [#] Specimen |
valueQuantity |
{count} |
| LOINC 21893-3 |
Regional lymph nodes positive [#] Specimen |
valueQuantity |
{count} |
TNM Staging
TNM is represented using MII Oncology profiles (not as Patho-Findings):
| Profile |
Description |
Scenario |
mii-pr-onko-tnm-t-kategorie |
Primary tumor (cT / pT) |
CNB (cT), RP, TUR, ENUC (pT) |
mii-pr-onko-tnm-n-kategorie |
Regional lymph nodes (cN / pN) |
CNB (cN), RP (pN) |
mii-pr-onko-tnm-m-kategorie |
Distant metastases (cM / pM) |
CNB (cM), RP (pM) |
Codes and ValueSets are defined in the MII Oncology IG (CodeSystem: https://www.uicc.org/resources/tnm).
ValueSets (Known Codes)
VS Laterality
| Code |
System |
Display |
| 24028007 |
SNOMED CT |
Right (qualifier value) |
| 7771000 |
SNOMED CT |
Left (qualifier value) |
| 51440002 |
SNOMED CT |
Right and left (qualifier value) |
VS Present / Absent
| Code |
System |
Display |
| 52101004 |
SNOMED CT |
Present (qualifier value) |
| 2667000 |
SNOMED CT |
Absent (qualifier value) |
VS Present / Not seen
| Code |
System |
Display |
| 52101004 |
SNOMED CT |
Present (qualifier value) |
| 47492008 |
SNOMED CT |
Not seen (qualifier value) |
| 2667000 |
SNOMED CT |
Absent (qualifier value) |
VS Yes / No
| Code |
System |
Display |
| 373066001 |
SNOMED CT |
Yes (qualifier value) |
| 373067005 |
SNOMED CT |
No (qualifier value) |
VS ICD-O-3 Morphology (Prostate)
Histologic types of prostate tumours, grouped according to the WHO Classification of Tumours,
5th edition (2022), Urinary and Male Genital Tumours. All codes are ICD-O-3.
Source column: IG = code used in the examples and diagnosis tables of this Implementation
Guide · ICCR = element of the ICCR prostate datasets (see Clinical Context)
but not currently instantiated here.
SCT Morphology gives the SNOMED CT morphologic abnormality, verified against SNOMED CT
International Edition 20260701. Entries marked ⚠ are not an exact ICD-O-3 equivalent — see notes.
Acinar adenocarcinoma and precursors
| Code |
Type |
SCT Morphology |
BfArM Display (official) |
Source |
| 8140/3 |
Acinar adenocarcinoma, NOS |
1187332001 Adenocarcinoma |
Adenokarzinom o.n.A. |
IG |
| 8490/3 |
Signet ring cell(-like) carcinoma |
87737001 Signet ring cell carcinoma |
— |
ICCR |
| 8572/3 |
Sarcomatoid carcinoma (spindle cell diff.) |
⚠ 65692009 Spindle cell carcinoma |
— |
ICCR |
| 8201/3 |
Invasive cribriform carcinoma (ICC) |
30156004 Cribriform carcinoma |
Kribriformes Karzinom o.n.A. |
IG |
| 8500/2 |
Intraductal carcinoma (IDC-P) |
1162814007 Intraductal carcinoma |
Nichtinfiltrierendes intraduktales Karzinom o.n.A. |
IG |
| 8148/2 |
High-grade prostatic intraepithelial neoplasia (HGPIN) |
⚠ see note |
— |
ICCR |
Ductal, squamous and basal cell tumours
| Code |
Type |
SCT Morphology |
BfArM Display (official) |
Source |
| 8500/3 |
Ductal adenocarcinoma |
82711006 Infiltrating duct carcinoma |
Invasives duktales Karzinom o.n.A. |
IG |
| 8560/3 |
Adenosquamous carcinoma |
59367005 Adenosquamous carcinoma |
— |
ICCR |
| 8070/3 |
Squamous cell carcinoma |
1162767002 Squamous cell carcinoma |
Plattenepithelkarzinom o.n.A. |
IG |
| 8147/3 |
Adenoid cystic (basal cell) carcinoma |
34603009 Basal cell adenocarcinoma |
— |
ICCR |
Urothelial tumours
| Code |
Type |
SCT Morphology |
BfArM Display (official) |
Source |
| 8120/3 |
Urothelial carcinoma |
27090000 Transitional cell carcinoma |
Uebergangszellkarzinom o.n.A. |
IG |
Neuroendocrine tumours
| Code |
Type |
SCT Morphology |
BfArM Display (official) |
Source |
| 8574/3 |
Adenocarcinoma with neuroendocrine differentiation |
128704005 Adenocarcinoma with neuroendocrine differentiation |
— |
ICCR |
| 8041/3 |
Small cell neuroendocrine carcinoma |
74364000 Small cell carcinoma |
Kleinzelliges Karzinom o.n.A. |
IG |
Mesenchymal / stromal tumours
| Code |
Type |
SCT Morphology |
BfArM Display (official) |
Source |
| 8935/1 |
Stromal tumour of uncertain malignant potential (STUMP) |
⚠ see note |
— |
ICCR |
| 8935/3 |
Stromal sarcoma |
128753005 Stromal sarcoma |
— |
ICCR |
| 8440/0 |
Cystadenoma (benign) |
47620003 Cystadenoma |
— |
ICCR |
Notes:
- 8572/3 — SNOMED
65692009 Spindle cell carcinoma is the closest active morphologic
abnormality, but its ICD-O-3 equivalent is 8032/3, not 8572/3. Post-coordination or a more
specific concept may be required.
- 8148/2 (HGPIN) — SNOMED has no active morphologic abnormality for HGPIN.
446711009 High
grade prostatic intraepithelial neoplasia is a (disorder), and the historic morphology code
128640002 Glandular intraepithelial neoplasia, grade III is inactive. This IG therefore
records HGPIN as a disorder — see the table Pre-malignant / Borderline Entities above.
- 8935/1 (STUMP) — no SNOMED morphologic abnormality could be identified. The only
prostate-specific related concept is
1260182007 Phyllodes tumor of prostate, which is a
(disorder) and covers a different entity. Open.
- 8147/3 —
34603009 matches the ICD-O-3 code exactly (basal cell adenocarcinoma). If the
adenoid cystic pattern is to be coded instead, 11671000 Adenoid cystic carcinoma corresponds to
ICD-O-3 8200/3.
- 8440/0 —
47620003 is the generic cystadenoma concept; SNOMED has no prostate-specific
cystadenoma.
- BfArM Display is only filled where it has been verified against the official German ICD-O-3
catalogue. The remaining entries still need to be checked.
- Three further WHO 2022 types are not included here because they are not part of the ICCR
datasets: 8480/3 mucinous (colloid) adenocarcinoma, 8240/3 well-differentiated neuroendocrine
tumour, 8013/3 large cell neuroendocrine carcinoma.
VS Gleason Pattern
| Code |
System |
Display |
| 369770006 |
SNOMED CT |
Gleason Pattern 1 (finding) |
| 369771005 |
SNOMED CT |
Gleason Pattern 2 (finding) |
| 369772003 |
SNOMED CT |
Gleason Pattern 3 (finding) |
| 369773008 |
SNOMED CT |
Gleason Pattern 4 (finding) |
| 369774002 |
SNOMED CT |
Gleason Pattern 5 (finding) |
VS Gleason Score
| Code |
System |
Display |
| 49878003 |
SNOMED CT |
Gleason grade score 2 out of 10 |
| 46677009 |
SNOMED CT |
Gleason grade score 3 out of 10 |
| 18430005 |
SNOMED CT |
Gleason grade score 4 out of 10 |
| 74013009 |
SNOMED CT |
Gleason grade score 5 out of 10 |
| 84556003 |
SNOMED CT |
Gleason grade score 6 out of 10 |
| 57403001 |
SNOMED CT |
Gleason grade score 7 out of 10 |
| 33013007 |
SNOMED CT |
Gleason grade score 8 out of 10 |
| 58925000 |
SNOMED CT |
Gleason grade score 9 out of 10 |
| 24514009 |
SNOMED CT |
Gleason grade score 10 out of 10 |
| 860741001 |
SNOMED CT |
Gleason score X (indeterminate) |
VS ISUP Grade Group
| Code |
System |
Display |
| 1279715000 |
SNOMED CT |
ISUP grade group 1 (Gleason score 3 + 3 = 6) |
| 1279714001 |
SNOMED CT |
ISUP grade group 2 (Gleason score 3 + 4 = 7) |
| 1279716004 |
SNOMED CT |
ISUP grade group 3 (Gleason score 4 + 3 = 7) |
| 1279717008 |
SNOMED CT |
ISUP grade group 4 (Gleason score 4 + 4 = 8) |
| 1279718003 |
SNOMED CT |
ISUP grade group 4 (Gleason score 3 + 5 = 8) |
| 1279719006 |
SNOMED CT |
ISUP grade group 4 (Gleason score 5 + 3 = 8) |
| 1279720000 |
SNOMED CT |
ISUP grade group 5 (Gleason score 4 + 5 = 9) |
| 1279721001 |
SNOMED CT |
ISUP grade group 5 (Gleason score 5 + 4 = 9) |
| 1279722008 |
SNOMED CT |
ISUP grade group 5 (Gleason score 5 + 5 = 10) |
VS WHO Differentiation Grade
| Code |
System |
Display |
| 1155701009 |
SNOMED CT |
G1: Well differentiated |
| 1155703007 |
SNOMED CT |
G2: Moderately differentiated |
| 1155704001 |
SNOMED CT |
G3: Poorly differentiated |
| 1155702002 |
SNOMED CT |
G4: Undifferentiated |
VS EPE Location (Standard)
Anatomical location of extraprostatic extension (EPE). Note: "posterolateral" (neurovascular bundle region) maps to SCT 25800008 "Structure of inferolateral surface of prostate" — SNOMED CT uses the anatomically more precise term "inferolateral".
| Code |
System |
Display |
| 68756004 |
SNOMED CT |
Structure of apex of prostate |
| 36082003 |
SNOMED CT |
Base of prostate |
| 70371002 |
SNOMED CT |
Structure of anterior surface of prostate |
| 5026003 |
SNOMED CT |
Structure of posterior surface of prostate |
| 25800008 |
SNOMED CT |
Structure of inferolateral surface of prostate |
VS EPE Location (Granular, with Laterality)
Use only when pathology reports provide this level of granularity (e.g. RP specimens with quadrant mapping).
| Code |
System |
Display |
| 716938006 |
SNOMED CT |
Right posterolateral apical peripheral zone of prostate |
| 716939003 |
SNOMED CT |
Left posterolateral apical peripheral zone of prostate |
| 716906001 |
SNOMED CT |
Right posterolateral basal peripheral zone of prostate |
| 716907005 |
SNOMED CT |
Left posterolateral basal peripheral zone of prostate |
| 716921007 |
SNOMED CT |
Right posterolateral middle peripheral zone of prostate |
| 716922000 |
SNOMED CT |
Left posterolateral middle peripheral zone of prostate |
VS Margin Status
| Code |
System |
Display |
| 55182004 |
SNOMED CT |
Surgical margin uninvolved by tumor |
| 61026006 |
SNOMED CT |
Surgical margin involved by tumor |
