Prognostic significance of tumor grade and stage in the patient with carcinoma of the prostate.

Available English language articles relating the grade, stage, and grade-stage of carcinoma of the prostate to evidence of tumor progression and survival in untreated and treated patients have been reviewed. Observations of the extremes of the spectrum of biological behavior of carcinoma of the prostate have been emphasized; for example, tumor progression, never or always; survival, never or always. The reported experiences indicated the following; namely, 1) reproducible biologically meaningful grading is achievable; however, grade cannot be utilized as a reliable indicator of stage; 2) accurate staging provides information that correlates with tumor progression and survival in groups of patients. However, unexpectedly prolonged or abbreviated progression-free survivals occur frequently enough in every stage, except perhaps patients with clinically unsuspected focal carcinoma, to indicate that the natural history and treatment response of individuals grouped by stage is far from homogeneous; 3) appropriate use of carefully obtained grade and stage information together maximizes the accuracy of prognostic attempts and is necessary to evaluate treatment results. At the present time, assessment and consideration of the grade and stage of carcinoma of the prostate is essential to formulate prognosis and advise and evaluate treatment in patients with this disease.