Pitfalls of Pathologic Staging in Prostate Cancer

ObjectivesThis manuscript reviews the possible pitfalls that may appear when the extent of prostate cancer is assessed by studying core biopsies and radical prostatectomy specimens.MethodsThe data presented are the result of a review of the literature and the author's experience contrasted with and implemented in discussion with a group of European urologists during a meeting in Monte Carlo, Monaco.ResultsA core biopsy of the extent of prostate cancer is made by means of indirect data with Gleason score and tumour volume as the main ones, in addition to intraprostatic perineural invasion. Consequently, they can only determine the risk of invasion but not the extent of prostate cancer. Radical prostatectomy pathologic staging, on the other hand, is a direct determination of prostate cancer, but the urologist must be perfectly aware of a series of limitations, such as quantity of periprostatic fat tissue, handling artefacts, and diagnosis of morphologic criteria, before deciding on further treatment.ConclusionsAlthough pathologic staging appears easy and totally reproducible among observers, we must be aware of its limitations in the interests of improving the evaluation and being able to make more solidly based decisions. Excellence results from a close relationship between the pathologist and urologist that leads to better handling of the specimens and improvement of the morphologic criteria.