Aid to accurate clinical staging-histopathologic grading in prostatic cancer

Recently, pathologic staging systems have been used to aid in accurate clinical assignment of prostatic disease. With this in mind, we reviewed retrospectively 130 patients who were diagnosed as having prostatic cancer either by needle biopsy or by study of transurethral resection chips. These specimens were graded by the Gleason and Roswell Park histopathologic grading systems. Grading was done by 2 pathologists independently and without knowledge of the results of final surgical staging. All patients were without evidence of metastases by standard diagnostic studies, and all underwent pelvic lymphadenectomy and radical prostatectomy if nodes were grossly negative. The surgical specimens were examined and the final clinical stage was correlated with the histopathologic grading. Independently, the Gleason rather than the Roswell Park system was slightly more accurate and was a more reliable predictor of the surgical stage of the disease. Of the patients with a Gleason sum of 7 or above 86 per cent had at least stage C disease, whereas the disease had been staged preoperatively as A or B. All patients with a Gleason sum of 2 to 5 had stage A or B disease.