Staging prostate cancer

Determining tumor stage provides a systematic way to describe the amount and the extent of a tumor at a certain point in time. In this short overview, the current version of the TNM system for prostate cancer is discussed. The TNM (tumor, lymph node, and metastasis) system is now used worldwide for determining tumor stage for prostate cancer. Tumor stage is essentially determined in two situations, at clinical evaluation of the patient (clinical stage) and after treatment by surgical removal of the prostate (pathological stage). In the ideal situation, clinical stage would be a reliable predictor of pathological stage, but in the current situation, tumors are clinically understaged in more than half of the cases. Additional clinical tools are needed to provide a firmer base on which the choice for patient treatment or management could be founded. Some of the criteria for the assessment of pathological stage are unclear. For instance, multifocal tumor, which occurs in more than half of the cases of prostate cancer, is not reckoned with in the current system, something that could hamper a correct and unambiguous assessment of pathological stage. In this report, we also discuss the criteria for extraprostatic extension, seminal vesicle invasion, and bladder neck invasion. Follow-up data obtained from a group of 123 patients that underwent radical prostatectomy at our hospital underline the importance of reporting the latter two.