Pathologic staging of prostate carcinoma. What are the issues?

BACKGROUND

Stage is a significant predictor of outcome for patients with carcinoma of the prostate. The American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) TNM staging system has gained general favor as the clinical staging system of choice for prostate carcinoma. With an increasing number of publications assessing prognostic markers for patients with carcinoma of the prostate, there is a need for the development of a uniform system of pathologic staging to support the clinical stage.

METHODS

The literature related to pathologic prognostic markers for patients with carcinoma of the prostate, particularly with regard to staging, was reviewed. From this, issues important to the development of a pathologic correlate to the AJCC/ UICC TNM system were identified.

RESULTS

A number of issues were identified related to the development of a pathologic staging system. For radical prostatectomy specimens some of the more important are whether or not subcategorization is needed in the pathologic classification of T2 tumors, definition and quantification of extraprostatic extension, and the reporting of positive surgical margins.

CONCLUSIONS

There is a need for the development of a pathologic equivalent to the AJCC/UICC TNM clinical staging system for prostate carcinoma. Consensus needs to be reached on several important issues prior to the adoption and testing of such a system.