Prostate Cancer Staging Poor Predictor of Recurrence
Prostate cancer staging has been the gold standard for determining recurrence outcomes. New research challenges the way the disease is staged, found in a new analysis to be a poor predictor of prostate cancer recurrence.
Localized Prostate Cancer Improperly Staged 35.4 Percent of Time
One problem found in an analysis of men with prostate cancer was inaccuracy of staging by physicians – something that occurred 35.4 percent of the time. The men were diagnosed with local disease, staged as T1, a, b and c and -T2 a, b and c. T2-c is the most advanced, but still localized form of cancer, meaning it is on both sides of the prostate but has not spread elsewhere.
The tools used by physicians are biopsy, ultrasound that can miss prostate spread outside of the gland and digital exam that may be subjective.
Adam Reese, MD, of the University of California, San Francisco says, "Our findings question the utility of our current staging system for localized prostate cancer.” Even after adjusting for the above, researchers still found staging did not predict whether cancer would return.
According to the American Cancer Society, “The stage (extent) of a cancer is one of the most important factors in choosing treatment options and predicting a patient's outlook. If your prostate biopsy confirms that you have cancer, more tests may be done to find out how far it has spread within the prostate, to nearby tissues, or to other parts of the body. This process is called staging.”
A PSA test is an added tool, as is the Gleason score that is assigned to a tumor characteristic after biopsy is performed and also subjective according to the Prostate Cancer Research Institute (PCRI).
Dr. Reese questions whether physicians inaccurately stage prostate cancer, found in 35.4 percent of cases. The conclusion from the study is that “errors in prostate cancer staging are common”, but cannot account for failure to predict recurrence of the disease after local prostatectomy. It may be that the current staging system is a poor predictor of outcome.
Cancer: DOI: 10.1002/cncr.25596