Current Status of Classification and Staging of Prostate Cancer

Abstract

The international TNM classification system for prostatic cancer has been recently revised and is most helpful for comparisons between various groups of patients. Today in the United States, the evaluation of certain factors related to clinical and pathologic staging are being further altered. These include primary grade of tumor and the extent and techniques of tumor staging. New tests for acid phosphatase and alkaline phosphatase isozymes are being concurrently evaluated. Advances in the past six years have contributed to further redefinition and subgrouping of previous conventional staging or prognostic assessment of prostatic cancer. Localized (Stage B, C), occult (Stage A), or generalized (Stage D) tumors are being subdivided. Although grade of the primary tumor has been thought to be important only recently has a consensus been achieved by the National Prostatic Cancer Project for a system of assessment that uses cellular patterns and nuclear changes. Aspiration cytology may be a useful adjuvant. The role and type of pelvic lymph node assessment, whether operative, radiographic, or by thin needle percutaneous aspiration, is undergoing additional study. In dealing with the so‐called occult (Stage A) lesions, a further subdivision, Stage A,/A₂has been employed. Similar changes in so‐called B₁/B₂, C₁/C₂, and D₁/D₂ also exist. These are valid attempts to further define extent of disease and overall true tumor burden. Nevertheless, it is still the privilege of the physician to determine the necessity and extent of the use of such classification. Today, the decision to provide therapeutic care based only on a clinical stage must be made with the knowledge of these variations of classification and staging as well as of other developments.