Adjusting The Prostate Cancer Staging System

(Ivanhoe Newswire) — A novel study faces up to the current staging system that ultimately determines the degree or severity of prostate cancer that has not metastasized.  The study found that there is no link between localized prostate cancer’s clinical stage and a patient’s risk of cancer recurrence after having his prostate removed.

One of the central purposes of staging prostate cancers is to assist physicians in determining a patient’s prognosis.  For example, a more advanced clinical stage should indicate an elevated risk of cancer recurrence after treatment. Surprisingly, however, researchers have found that clinical stage is of questionable utility for predicting disease recurrence after surgical removal of the prostate (radical prostatectomy) in patients with localized prostate cancer.

Adam Reese, MD, of the University of California, San Francisco, and his colleagues questioned whether staging errors are accountable for this inconsistency.  In other words, do physicians often mistakenly stage prostate cancer cases, and in doing so, does this account for the differing consistency of clinical staging for predicting prostate cancer outcomes?

The investigators reported that clinical stage was allocated erroneously in 35.4 percent of 3,875 men in a multi-institutional national disease registry.  The preponderance of these staging errors occurred for the reason that physicians generally discounted the results of transrectal ultrasound tests and wrongly incorporated biopsy results when assigning stage.

Even after correcting these staging errors, nevertheless, there was no distinct connection between clinical stage and prostate cancer recurrence subsequent to radical prostatectomy.  “Our findings question the utility of our current staging system for localized prostate cancer,” which Dr. Reese was quoted as saying.

SOURCE: CANCER, 22 November 2010

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