To the Editor.
—All nonpalpable cancers are not stage Tic. The interesting article by Dr Epstein and colleagues1 defines in great detail the pathologic outcome of prostatectomy for nonpalpable prostate cancers as contrasted with T1a tumors diagnosed at transurethal resection of the the prostate and palpable T2 cancers. However, these nonpalpable cancers are not all correctly staged Tic, as the 1992 American Joint Committee on Cancer2 system upstages nonpalpable cancers based on imaging findings (transrectal ultrasound [TRUS] and magnetic resonance imaging). Epstein and colleagues report that 103 of their 157 patients had preoperative TRUS with reports available, and presumably more than 103 had TRUS done to assist biopsy. The results of TRUS appear to have been omitted from the staging of these patients and do not appear in the article. Consequently, none of the patients with an abnormality on TRUS was advanced to the correct American Joint Committee
Kaplan EJ, Hanks GE. Use of Transrectal Ultrasound to Stage Prostate Cancer. JAMA. 1994;272(7):516. doi:10.1001/jama.1994.03520070034024