BERKELEY, CA (UroToday.com) - Our institution previously performed an analysis of the CaPSURE database, investigating recurrence rates in men with localized prostate cancer treated with radical prostatectomy.
Despite the natural assumption that cT2 tumors represent more advanced lesions, we found that biochemical recurrence rates did not differ between clinical T2 and T1 tumors.
The clinical staging guidelines for localized prostate cancer are somewhat ambiguous. The American Joint Committee on Cancer (AJCC) staging manual states that all of the information available before the first definitive treatment may be used for clinical staging. It is our interpretation, however, that biopsy information does not factor into clinical stage assignment; otherwise, by definition, no patient would be assigned to clinical stage T1c.
Perhaps due to these ambiguities, we have observed significant variation amongst urologists in the interpretation and application of clinical staging criteria. For example, practitioners often appear to inappropriately incorporate biopsy information into clinical stage assignment. Furthermore, it appears abnormal findings on transrectal ultrasound (TRUS) are often ignored when determining clinical stage, despite guidelines in the staging manual stating that these lesions are sufficient to elevate a patient to clinical stage T2. In the current study, we aimed to better characterize errors made when assigning prostate cancer clinical stage. Additionally, we hypothesized that a high prevalence of clinical staging errors may be responsible for the lack of association we had previously reported between clinical stage and biochemical recurrence rates for localized prostate cancer.
We investigated 3,875 men with localized prostate cancer from the CaPSURE database, comprising patients accrued at urologic practices, mostly community-based, across the U.S. We determined the correct clinical stage, according to the AJCC cancer staging manual, based on digital rectal exam (DRE) and TRUS findings. Correct clinical stage was compared to the clinical stage that was assigned by CaPSURE practitioners. We found that clinical stage was assigned incorrectly in 1,370 of the 3,875 men in our study (35.4%). Staging errors most often occurred when practitioners ignored TRUS findings or inappropriately considered biopsy results when assigning clinical stage.
We then corrected staging errors in those patients assigned an incorrect clinical stage. However, even after correction of these staging errors, we failed to identify an association between advanced clinical stage and biochemical recurrence after radical prostatectomy.
Our findings suggest that there is wide variation in the interpretation and application of clinical staging criteria. Nonetheless, even with correctly-applied staging criteria there does not appear to be a significant association between clinical stage and prostate cancer recurrence after radical prostatectomy. These results question the utility of a DRE and/or TRUS-based staging system for localized prostate cancer.
Adam C. Reese, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.