Staging prostate cancer

Determining tumor stage provides a systematic way to describe the amount an d the extent of a tumor at a certain point in time. In this short overview, the current version of the TNM system for prostate cancer is discussed. Th e TNM (tumor, lymph node, and metastasis) system is now used worldwide for determining tumor stage for prostate cancer. Tumor stage is essentially det ermined in two situations, at clinical evaluation of the patient (clinical stage) and after treatment by surgical removal of the prostate (pathologica l stage). In the ideal situation, clinical stage would be a reliable predic tor of pathological stage, but in the current situation, tumors are clinica lly understaged in more than half of the cases. Additional clinical tools a re needed to provide a firmer base on which the choice for patient treatmen t or management could be founded. Some of the criteria for the assessment o f pathological stage are unclear. For instance, multifocal tumor, which occ urs in more than half of the cases of prostate cancer, is not reckoned with in the current system, something that could hamper a correct and unambiguo us assessment of pathological stage. In this report, we also discuss the cr iteria for extraprostatic extension, seminal vesicle invasion, and bladder neck invasion. Follow-up data obtained from a group of 123 patients that un derwent radical prostatectomy at our hospital underline the importance of r eporting the latter two. (C) 2000 Wiley-Liss, Inc.