Adenocarcinoma of the prostate: biopsy to whole mount. Denver VA experience

Clinical understaging abounds in adenocarcinoma of the prostate. The preoperative prostate-specific antigen is not useful in preoperative staging, although enzymatic acid phosphatase elevation is associated with positive nodes in two-thirds of patients. Whole mount evaluation of radical prostatectomy specimens reveals tumor multicentricity in more than half the patients and tumor extension beyond the prostatic capsule in the majority of patients. A significant number of patients have a final tumor grade higher than that initially assigned. Capsule penetration by tumor is a factor of tumor grade as is volume.