If a man's prostate cancer is localized - still inside the prostate, has not spread - and he has his prostate surgically removed, his risk of prostate cancer recurrence is not determined by the stage of his cancer, researchers reveal in the medical journal Cancer. The extent or severity of prostate cancer that has not metastasized has been thought of as a predictor of recurrence - this study and its researchers challenge the current staging system.
The main reason for staging prostate cancer is so that the doctor can determine the patient's outlook, or prognosis. Most doctors currently agree that a higher stage of cancer, even if it has not spread, means a higher risk of it coming back after treatment.
Adam Reese, MD, of the University of California, San Francisco and team set out to find out whether this was true. They were surprised to find that the clinical stage of prostate cancer is not that useful in predicting whether the cancer is going to come back after a radical prostatectomy (surgically removing the prostate) in patients whose cancer is localized.
The team wondered whether the reason was that there really was no link, or perhaps mistakes were being made in the clinical staging. Put simply, were the staging results unreliable?
In a sample of 3,875 men from a multi-institutional national disease registry, the researchers found that 35.4% of the clinical stagings were wrong. The main reason for the mistakes was that doctors often ignored the transrectal ultrasound test results and incorrectly incorporated biopsy results when assigning stage.
What surprised the authors even further was that after correcting the staging mistakes, there still was no link between how advanced the cancer was (if localized) and recurrence risk after radical prostatectomy.
Dr. Reese said:
- "Our findings question the utility of our current staging system for localized prostate cancer."
Adam C. Reese, Natalia Sadetsky, Peter R. Carroll, and Matthew R. Cooperberg.
CANCER Published Online: November 22, 2010 (DOI: 10.1002/cncr.25596).
Written by Christian Nordqvist