Staging Prostatic Cancer: A Different Distribution

Abstract

A review of 300 recent cases of prostatic adenocarcinoma and use of current staging methods revealed a marked change in the distribution of the various stages of the disease from previous classical reports. Stage A disease, the incidental carcinoma, now assumes a significant proportion of new cases (37%) and full staging procedures must be done at least in all A2 cases (13%). This is especially true in those patients with higher grade lesions. One of the challenges facing urologists in the future is to detect which of these patients with stage A2 disease are at greater risk and to investigate the use of early therapy to determine whether the natural history of this disease can be affected. Stage B disease, clinical B1 disease, often pathologically B2, C or D1, may be curable by other than radical prostatectomy with its impotence and threat to continence. Controlled, randomized studies are needed to establish the natural history of the disease now since its stage is more finely and accurately determined and to compare the various treatment modalities, i.e., is radical prostatectomy, external beam radiotherapy and implantation therapy, with that history. B2 disease, surgically less curable with a higher percentage of cases revealing local lymph node spread at staging lymphadenectomy, also must have controlled studies. Stage C disease (50% of which becomes stage D1 with pelvic lymphadenectomy), usually surgically incurable, must be treated and evaluated with modalities other than an operation alone also to see if increased survival, free of disease, can be achieved.