Pitfalls in preoperative staging in prostate cancer.

Clinical staging in 60 patients with adenocarcinoma of the prostate was compared with pathologic staging to identify factors which may contribute to staging errors. Understaging was directly related to tumor stage and was documented in 0 per cent of A2, 26.5 per cent of B1, and 66.7 per cent of B2 patients. Capsular invasion was found in 11.8 per cent of B1 and 52.4 per cent of B2 patients, seminal vesicle extension in 17.7 per cent of B1 and 52.4 per cent of B2 patients, and lymph node metastases in 2.9 per cent of B1 and 28.6 per cent of B2 patients. The majority of patients who had unnoticed gross extension of the tumor beyond the prostate underwent transurethral resection of the prostate or failed irradiation therapy prior to radical prostatectomy. The results suggest that intraprostatic or periprostatic changes caused by previous treatment to the prostate may interfere with the preoperative staging.