Clinical Staging in Carcinoma of the Prostate: Current Aspects

  • B. J. Schmitz-Dräger
  • T. Ebert
  • R. Ackermann
Conference paper
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 126)


Radical prostatectomy (RP) and megavolt radiotherapy are assumed to be effective in the treatment of localized carcinoma of the prostate (CaP). Several studies have demonstrated that where there is extracapsular and seminal vesicle infiltration, or lymph node metastases, unfavorable results are associated with local treatments [4,15,19,30,65]. Report by some authors, however, in patients with locally advanced disease or lymph node metastases suggest a beneficial effect with RP even in more advanced tumor stages [46,62,68,69]. Tumor debulking by inductive antiandrogen treatment with subsequent RP represents another approach to curing patients with metastatic disease. The advent of new therapeutic strategies and the introduction of modern imaging modalities has led to the question of whether current staging procedures still satisfy clinical requirements. The aim of this manuscript is to analyze the accuracy of modern clinical staging modalities and to evaluate their possible impact on the treatment of patients with CaP.


Radical Prostatectomy Seminal Vesicle Pelvic Lymph Node Pelvic Lymphadenectomy Radical Retropubic Prostatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Andriole GL, Kavoussi LR, Torrence RJ, Lepor H, Catalona WJ (1988) Transrectal ultrasonography in the diagnosis and staging of carcinoma of the prostate. J Urol 140:758–760PubMedGoogle Scholar
  2. 2.
    Benson KH, Watson RA, Spring DB, Agee RE (1981) The value of computerized tomography in evaluation of pelvic lymph nodes. J Urol 126:63–64PubMedGoogle Scholar
  3. 3.
    Bezzi M, Kressel HY, Allen KS, Schiebler ML, Altman HG, Wein AJ, Pollack HW (1988) iProstatic carcinoma: staging with MR imaging at 1.5 T. Radiology 169:339–346PubMedGoogle Scholar
  4. 4.
    Boxer RJ, Kaufman JJ, Goodwin WE (1977) Radical prostatectomy for carcinoma of the prostate 1951-1976. A review of 329 patients. J Urol 117:208–211PubMedGoogle Scholar
  5. 5.
    Brendler CB, Cleeve LK, Anderson EE, Paulson DF (1980) Staging pelvic lymphadenectomy for carcinoma of the prostate: risk versus benefit. J Urol 124:849–850PubMedGoogle Scholar
  6. 6.
    Bruce AW, O’Cleireachain F, Morales A, Awad SA (1977) Carcinoma of the prostate: a critical look at staging. J Urol 117:319–322PubMedGoogle Scholar
  7. 7.
    Bryan PJ, Butler HE, Nelson AD, LiPuma JP, Kopiwoda SY, Resnick MI, Cohen AM, Haaga JR (1986) Magnetic resonance imaging of the prostate. AJR 146:543–548PubMedGoogle Scholar
  8. 8.
    Buonocore E, Hesemann C, Pavlicek W, Montie JE (1984) Clinical and in vitro magnetic resonance imaging of prostatic carcinoma. AJR 143:1267–1272PubMedGoogle Scholar
  9. 9.
    Carrol CL, Sommer FG, McNeal JE, Stamey TA (1987) The abnormal prostate: MR imaging at 1.5 T with histopathologic correlation. Radiology 163:521–525PubMedGoogle Scholar
  10. 10.
    Catalona WJ, Stein AJ (1982) Accuracy of frozen section detection of lymph node metastases in prostatic carcinoma. J Urol 127:460–461PubMedGoogle Scholar
  11. 11.
    Catalona WJ, Stein AJ (1982) Staging errors in clinically localized prostatic cancer. J Urol 127:452–456PubMedGoogle Scholar
  12. 12.
    Caty A, Gosselin P, Cazin JL, Dehaut JM, Adenis L (1988) Significance of PSA and PAP in patients with or without prostatic cancer. Am J Clin Oncol Suppl 2:63–64CrossRefGoogle Scholar
  13. 13.
    Clements R, Griffiths GJ, Peeling WB, Roberts EE, Evans KT (1988) How accurate is the index Finger? A comparison of digital and ultrasound examination of the prostatic nodule. Clin Radiol 39:87–89PubMedCrossRefGoogle Scholar
  14. 14.
    Cordes M, Tunn UW, Neidl K, Haasner E (1987) Prostatakarzinom. Stadieneinteilung durch transrektale Prostatasonographie und Computertomographie mit histopathologischer Korrelation. Fortschr Röntgenstr 146:412–414CrossRefGoogle Scholar
  15. 15.
    Correa RJ Jr, Gibbons RP, Cummings KB, Mason JT (1977) Total prostatectomy for stage B carcinoma of the prostate. J Urol 117:328–329PubMedGoogle Scholar
  16. 16.
    Dähnert WF, Hamper UM, Eggleston JC, Walsh PC, Sanders RC (1986) Prostatic evaluation by transrectal sonography with histopathologic correlation: the echopenic appearance of early carcinoma. Radiology 158:97–102PubMedGoogle Scholar
  17. 17.
    Denis L, Appel L, Broos J, Declerq G (1980) Evaluation of prostatic cancer by transrectal ultrasonotomography and CT scan. Acta Urol Belg 48:71–77PubMedGoogle Scholar
  18. 18.
    Ebert T, Schmitz-Dräger BJ, Bürrig K-F, Miller S, Pauli N, Kahn T, Ackermann R (1991) Accuracy of imaging modalities in staging the local extent of prostate cancer. Urol Clin North Am 18:453–457PubMedGoogle Scholar
  19. 19.
    Elder JS, Jewett HJ, Walsh PC (1982) Radical perineal prostatectomy for clinical stage B2 carcinoma of the prostate. J Urol 127:704–709PubMedGoogle Scholar
  20. 20.
    Ercole CJ, Lange PH, Mathisen M, Chiou RK, Reddy PK, Vessella RL (1987) Prostatic specific antigen and prostatic acid phosphatase in the monitoring and staging of patients with prostatic cancer. J Urol 138:1181–1184PubMedGoogle Scholar
  21. 21.
    Fowler JE, Togerson L, McLeod DG, Stutzman RE (1981) Radical prostatectomy with pelvic lymphadenectomy: Observations on the accuracy of staging with lymph node frozen sections. J Urol 126:618–619PubMedGoogle Scholar
  22. 22.
    Fowler JE, Whitmore WF (1981) The incidence and extent of pelvic lymph node metastases in apparently localized prostatic cancer. Cancer 47:2941–2945PubMedCrossRefGoogle Scholar
  23. 23.
    Freiha FS, Pistenma DA, Bagshaw MA (1979) Pelvic lymphadenectomy for staging prostatic carcinoma: is it always necessary? J Urol 122:176–177PubMedGoogle Scholar
  24. 24.
    Friedman AC, Seidmon EJ, Radecki PD, Lev-Toaff A, Caroline DF (1988) Relative merits of MRI, transrectal endosonography and CT in diagnosis and staging of carcinoma of prostate. Urology 31:530–537PubMedCrossRefGoogle Scholar
  25. 25.
    Fujino A, Scardino PT (1985) Transrectal ultrasonography for prostatic cancer: its value in staging and monitoring the response to radiotherapy and chemotherapy. J Urol 133:806–810PubMedGoogle Scholar
  26. 26.
    Gevenois PA, van Regemorter G, Ghysels M, Delepaut A, van Gansbeke D, Struyven J (1988) IRM de la prostate. Imagerie calculée. J Radiol 89:275–279Google Scholar
  27. 27.
    Golimbu M, Morales P, Al-Askari S, Brown J (1979) Extended pelvic lymphadenectomy for prostatic cancer. J Urol 121:617–620PubMedGoogle Scholar
  28. 28.
    Golimbu M, Morales P, Al-Askari S, Shulman Y (1981) CAT scanning in staging of prostatic cancer. Urology 18:305–308PubMedCrossRefGoogle Scholar
  29. 29.
    Grossman IC, Carpiniello V, Greenberg SH, Malloy TR, Wein AJ (1980) Staging pelvic lymphadenectomy for carcinoma of the prostate: review of 91 cases. J Urol 124:632–634PubMedGoogle Scholar
  30. 30.
    Grups JW (1988) Langzeitergebnisse der radikalen Prostatektomie. Urologe [A] 27:348–351Google Scholar
  31. 31.
    Hermanek P (1986) Neue TNM/pTNM-Klassifikation und Stadieneinteilung urologischer Tumoren ab 1987. Urologe [B] 26:193–197Google Scholar
  32. 32.
    Hoekstra WJ, Schröder FH (1981) The role of lymphangiography in the staging of prostatic cancer. Prostate 2:433–436PubMedCrossRefGoogle Scholar
  33. 33.
    Houston ST, Jones LW, Waluch V (1988) Nuclear magnetic resonance imaging in detecting and staging prostatic cancer. Urology 31:171–175PubMedCrossRefGoogle Scholar
  34. 34.
    Hricak H, Dooms GC, Jeffrey RB, Avallone A, Jacobs D, Benton WK, Narayan P, Tanagho EA (1987) Prostatic carcinoma: staging by clinical assessment, CT, and MR imaging. Radiology 162:331–336PubMedGoogle Scholar
  35. 35.
    Hricak H, Williams RD, Spring DB, Moon KL Jr, Hedgcock MW, Watson RA, Crooks LE (1983) Anatomy and pathology of the male pelvis by magnetic resonance imaging. AJR 141:1101–1110PubMedGoogle Scholar
  36. 36.
    Jewett HJ (1949) Radical perineal prostatectomy for cancer of the prostate: an analysis of 190 cases. J Urol 61:277–280PubMedGoogle Scholar
  37. 37.
    Kahn T, Bürrig K-F, Schmitz-Dräger B, Fürst G, Stork W, Mödder U (1989) Magnetic resonance tomography of prostatic cancer. Histopathologic correlation. Radiologe 29:144–149PubMedGoogle Scholar
  38. 38.
    Küper K, Hess CF, Griebel J, Peter K (1986) Die Darstellung des Prostatakarzinoms in der Kernspintomographie bei 1,5 Tesla. Fortschr Röntgenstr 144:428–434CrossRefGoogle Scholar
  39. 39.
    Liebner EJ, Stefani S, Uro-Oncology Group (1980) An evaluation of lymphography with nodal biopsy in localized carcinoma of the prostate. Cancer 45:728–734PubMedCrossRefGoogle Scholar
  40. 40.
    Lieskovsky G, Skinner DG, Weisenburger T (1980) Pelvic lymphadenectomy in the management of carcinoma of the prostate. J Urol 124:635–638PubMedGoogle Scholar
  41. 41.
    Ling D, Lee JKT, Heiken JP, Balfe DM, Glazer HS, McClennan BL (1986) Prostatic carcinoma and benign prostatic hyperplasia: inability of MR imaging to distinguish between the two diseases. Radiology 158:103–107PubMedGoogle Scholar
  42. 42.
    Loening SA, Schmidt JD, Brown RC, Hawtrey CE, Fallon B, Culp DA (1977) A comparison between lymphangiography and pelvic node dissection in the staging of prostatic cancer. J Urol 117:752–756PubMedGoogle Scholar
  43. 43.
    McCullough DL (1980) Surgical staging of carcinoma of the prostate. Cancer 45:1902–1905PubMedGoogle Scholar
  44. 44.
    McLaughlin AP, Saltzstein SL, McCullough DL, Gittes RF (1976) Prostatic carcinoma: incidence and location of unsuspected lymphatic metastases. J Urol 115:89–94PubMedGoogle Scholar
  45. 45.
    Middleton AW (1981) Pelvic lymphadenectomy with modified radical retropubic prostatectomy as a single operation: technique used and results in 50 consecutive cases. J Urol 125:353–356PubMedGoogle Scholar
  46. 46.
    Morales P, Golimbu M (1980) The therapeutic role of pelvic lymphadenectomy in prostatic cancer. Urol Clin North Am 7:623–628PubMedGoogle Scholar
  47. 47.
    Mukamel E, Hannah J, Barbaric Z, deKernion JB (1986) The value of computerized tomography scan and magnetic resonance imaging in staging prostatic carcinoma: comparison with the clinical and histological staging. J Urol 136:1231–1233PubMedGoogle Scholar
  48. 48.
    Nicholson TC, Richie JP (1977) Pelvic lymphadenectomy for stage B1 adenocarcinoma of the prostate: justified or not? J Urol 117:199–201PubMedGoogle Scholar
  49. 49.
    Palken M, Cobb OE, Warren BH, Hoak DC (1990) Prostate cancer: correlation of digital rectal examination, transrectal ultrasound and prostate specific antigen levels with tumor volumes in radical prostatectomy specimens. J Urol 143:115–1162Google Scholar
  50. 50.
    Paulson DF, Uro-Oncology Research Group (1979) The impact of current staging procedures in assessing disease extent of prostatic adenocarcinoma. J Urol 121:300–302Google Scholar
  51. 51.
    Phillips ME, Kressel HY, Spritzer CE, Arger PH, Wein AJ, Marinelli D, Axel L, Gefter WB, Pollack HM (1987) Prostatic disorders: MR imaging at 1.5 T. Radiology 164:386–392PubMedGoogle Scholar
  52. 52.
    Pontes JE, Eisenkraft S, Watanabe H, Ohe H, Saitoh M, Murphy GP (1985) Preoperative evaluation of localized prostatic carcinoma by transrectal ultrasonography. J Urol 134:289–291PubMedGoogle Scholar
  53. 53.
    Poon PY, McCallum RW, Henkelman MM, Bronskill MJ, Sutcliffe SB, Jewett MA, Rider WD, Bruce AW (1985) Magnetic resonance imaging of the prostate. Radiology 154:143–149PubMedGoogle Scholar
  54. 54.
    Reikeras O, Due J, Sundsfjord JA (1988) Bone scintigraphy, radiographic survey and prostatic acid phosphatase in patients with prostatic carcinoma. A comparison of sensitivity. Int Urol Nephrol 20:51–54PubMedCrossRefGoogle Scholar
  55. 55.
    Resnick MI, Willard JW, Boyce WH (1980) Transrectal ultrasonography in the evaluation of patients with prostatic carcinoma. J Urol 124:482–484PubMedGoogle Scholar
  56. 56.
    Sadlowski RW, Donohue DJ, Richman AV, Sharpe JR, Finney RP (1983) Accuracy of frozen section diagnosis in pelvic lymph node staging biopsies for adenocarcinoma of the prostate. J Urol 129:324–326PubMedGoogle Scholar
  57. 57.
    Salo JO, Kivisaari L, Rannikko S, Lehtonen T (1987) Computerized tomography and transrectal ultrasound in the assessment of local extension of prostatic cancer before radical retropubic prostatectomy. J Urol 137:435–438PubMedGoogle Scholar
  58. 58.
    Salo JO, Ranniko S, Makinen J, Lehtonen T (1987) Echogenic structure of prostatic cancer imaged on radical prostatectomy specimens. Prostate 10:1–9PubMedCrossRefGoogle Scholar
  59. 59.
    Saltzstein SL, McLaughlin AP (1977) Clinicopathologic features of unsuspected regional lymph node metastases in prostatic adenocarcinoma. Cancer 40:1212–1221PubMedCrossRefGoogle Scholar
  60. 60.
    Sawczuk IS, deVere White R, Gold RP, Olsson CA (1983) Sensitivity of computed tomography in evaluation of pelvic lymph node metastases from carcinoma of bladder and prostate. Urology 21:81–84PubMedCrossRefGoogle Scholar
  61. 61.
    Schaffer DL, Pendergrass HP (1976) Comparison of enzyme, clinical radiographic, and radionuclide methods of detecting bone metastasis from carcinoma of the prostate. Radiology 121:431–434PubMedGoogle Scholar
  62. 62.
    Schmidt JD, McLaughlin AP III, Saltzstein SL, Garcia-Reyes R (1982) Risk factors for the development of distant metastases in patients undergoing pelvic lymphadenectomy for prostatic cancer. Am J Surg 144:131–134PubMedCrossRefGoogle Scholar
  63. 63.
    Spellman MC, Castellino RA, Ray GR, Pistenma DA, Bagshaw MA (1977) An evaluation of lymphography in localized carcinoma of the prostate. Radiology 125:637–644PubMedGoogle Scholar
  64. 64.
    Stamey TA, Kabalin JN (1989) Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. I. Untreated patients. J Urol 141:1070–1075PubMedGoogle Scholar
  65. 65.
    Veenema RJ, Gursel EO, Lattimer JK (1977) Radical retropubic prostatectomy for cancer: a 20-year experience. J Urol 117:330–331PubMedGoogle Scholar
  66. 66.
    Watanabe H, Igari D, Tanahashi Y, Harada K, Saitoh M (1975) Transrectal ultrasonotomography of the prostate. J Urol 114:734–739PubMedGoogle Scholar
  67. 67.
    Weinerman PM, Arger PH, Coleman BG, Pollack HM, Banner MP, Wein AJ (1985) Pelvic adenopathy from bladder and prostate carcinoma: detection by rapid sequence computed tomography. AJR 140:95–99Google Scholar
  68. 68.
    Zincke H, Utz DC (1983) Radical surgery for stage Dl prostate cancer. Semin Urol 1:253–260PubMedGoogle Scholar
  69. 69.
    Zincke H, Utz DC, Taylor WF (1986) Bilateral pelvic lymphadenectomy and radical prostatectomy for clinical stage C prostatic cancer: role of adjuvant treatment for residual cancer and in disease progression. J Urol 135:1199–1205PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • B. J. Schmitz-Dräger
    • 1
  • T. Ebert
    • 1
  • R. Ackermann
    • 1
  1. 1.Urologische AbteilungHeinrich-Heine-UniversitätDüsseldorfGermany

Personalised recommendations