Staging of prostate cancer.

The clinical and pathologic staging of prostate cancer involves determination of the anatomic extent and burden of tumor based on the best available data. Two major classification schemes are currently used: the modified American system and the TNM system [primary tumor (T), regional lymph node (N), and metastases (M)]. Both systems stratify patients according to the method of tumor detection, separating nonpalpable "incidental" prostate cancers detected during transurethral resection for clinically benign prostatic hyperplasia (BPH) and palpable cancers detected by digital rectal examination. These staging systems also recognize nonpalpable tumors detected by an elevated serum prostate-specific antigen (PSA) level or an abnormal transrectal ultrasound image. Current staging is limited by a significant level of clinical understaging (up to 59%, in our experience) and overstaging (up to 5%) according to comparison with pathologic examination of resected specimens. Proposed improvements in staging include preoperative systematic sextant biopsies to assess tumor volume, volume-based prognostic index, and a multiple prognostic index. In this report, we evaluate the current aspects of clinical and pathologic staging of prostate cancer with emphasis on the early stages in which there is the greatest chance of cure.