Staging Errors in Clinically Localized Prostatic Cancer

The interrelationships among tumor grade, local tumor extension, lymph node involvement and early treatment failure were examined in 96 consecutive patients with clinical stage A (11 patients) or B (85 patients) prostatic cancer who were considered potential candidates for radical prostatectomy. In this series 20 of the 82 patients (24 per cent) who underwent radical prostatectomy had local tumor extension beyond the prostatic capsule and 27 of the 88 patients (31 per cent) who had lymph node dissections had nodal involvement. Of the entire group of 96 patients 38 (40 per cent) had either local extension and/or nodal involvement. A direct correlation was observed between clinical stage and the incidence of local tumor extension but not between clinical stage and nodal involvement. However, there was a striking correlation between surgical stage and lymph node involvement in patients who underwent radical prostatectomy. A direct correlation also was observed between tumor grade, and local extension and nodal involvement. Analysis of multiple parameters revealed that clinical grade of tumor considered together were more predictive of nodal involvement than either parameter alone. Early treatment failures occurred in 5 patients, all of whom were understaged clinically.