Current problems in staging and grading prostatic carcinoma with special reference to T3 carcinoma of the prostate

Abstract

The staging and grading results of 107 patients considered to be potential candidates for radical prostatectomy are described. In all patients lymph node status was proven histologically. Understaging of the local tumor was found in 51.4% of the patients. Local overstaging in clinical T3 patients was noted in 23%. Undergrading of the pre-operative biopsy specimen was noted in 42% of the patients, while overgrading occurred in 6% of the patients. False negative frozen sections of pelvic lymph nodes occurred in 7%. The percentage of false negative frozen sections was higher in higher T-categories and higher tumor grades. The presence of lymph node metastases is a function of T-category and tumor grade. In T3G3 patients positive nodes were found in 90% of the cases. Bipedal lymphangiography and CT-scanning were of no value in detecting lymph node metastases in patients not being T3 or G3. In clinical T3 patients total tumor removal, as defined by negative pelvic lymph nodes and negative margins of resection, could be achieved in 30% of the cases.