Identification and therapy of stage B prostate carcinoma.

We identify Stage B1 lesions using a combination of clinical and pathologic criteria. Only patients with normal acid phosphatase, chest x-ray and radioisotope bone scan are considered surgical candidates. Patients with a palpable nodule confined to the prostate gland undergo biopsy of the nodule and the contralateral lobe. Our preference is to use the fine needle aspiration which is as accurate as the large needle biopsy, and is associated with less morbidity. Furthermore, local reaction and scarring is less following the fine needle aspiration, making the surgical procedure less difficult. According to the pathologic findings, the tumor is assigned either Stage B1 or B2. The delineation of the size and extent of the tumor is best determined by the digital rectal examination, though the inaccuracy, as shown above, will be directly related to the size of the tumor, the grade of the tumor, and prior therapy. Examination of the prostate under anesthesia has not improved our staging accuracy. CT scan is relied upon mainly to assess the status of the pelvic lymph nodes, and enlarged, suspicious lymph nodes are biopsied by fine needle aspiration. Obviously, only patients with normal acid phosphatase and normal bone scans are considered for surgical therapy. In spite of the inaccuracy of the current staging methods, the probability of tumor-free survival of patients with clinical Stage B tumors is extremely high after radical prostatectomy. Many patients with capsular and seminal vesicle extension remain free of tumor after long-term follow-up (Zincke et al., 1982). Therefore, even within the limitations of our current staging methods, the results of radical prostatectomy for Stage B carcinoma remain excellent, and staging inaccuracy should not deter an attempt at surgical cure.