STAGING OF PROSTATE-CANCER

The clinical and pathologic staging of prostate cancer involves determ ination of the anatomic extent and burden of tumor based on the best a vailable data. Two major classification schemes are currently used: th e modified American system and the TNM system [primary tumor (T), regi onal lymph node (N), and metastases (M)]. Both systems stratify patien ts according to the method of tumor detection, separating nonpalpable ''incidental'' prostate cancers detected during transurethral resectio n for clinically benign prostatic hyperplasia (BPH) and palpable cance rs detected by digital rectal examination. These staging systems also recognize nonpalpable tumors detected by an elevated serum prostate-sp ecific antigen (PSA) level or an abnormal transrectal ultrasound image . Current staging is limited by a significant level of clinical unders taging (up to 59%, in our experience) and over-staging ( up to 5%) acc ording to comparison with pathologic examination of resected specimens . Proposed improvements in staging include preoperative systematic sex tant biopsies to assess tumor volume, volume-based prognostic index, a nd a multiple prognostic index. In this report, we evaluate the curren t aspects of clinical and pathologic staging of prostate cancer with e mphasis on the early stages in which there is the greatest chance of c ure. (C) 1994 Wiley-Liss, Inc.