[Diagnostic approach to candidates for radical prostatectomy: value of echographic staging]

The last 118 candidates to RPV in the urological department of the CHU Liège were retrospectively analyzed in regard of echographic patterns, anatomopathology and PSA levels. The local extension of the cancer was defined following its echographic patterns with reference to the TNM classification (UICC, 1992). The PSA density (PSAd) and the histological grade of the bioptic specimens were studied. There is a good correlation between the echographic stage, the mean level of PSAd and the anatomical extent of the cancer on the surgical specimen. In cancers classified as T2, 2 sub sub-groups may be identified with different prognosis: T2A and T2B in which a nodal extension or an extra-capsular growth is present in 1/3 of the cases and T2C in which such an extension is observed in one half of the cases. In biopsy grades IV or V, a microscopic involvement of the nodes is observed in 50% of the cases. In the remaining 50% with negative nodes, the surgical specimen shows an extra-capsular extension in 2 cases out of 3 (roughly, 80% of the grades IV-V are over the possibility of cure with surgery alone). The analysis of the specific echographic patterns identifies 3 morphological aspects which seem to carry a bad prognosis: posterior capsular deformity, junctional irregularity and heterogeneity of the lesion. The analysis of PSAd and of the tumoral volume measured by ultrasounds identifies 2 clear-cut values (PSAd > 1 and volume > 3 cm3) over which we now advocate a coelioscopic LAD (important risk of positive nodes).