Problems in Staging Prostate Cancer

John Swanson, MD
staging is extremely important in assessing mortality and morbidity risk for any cancer. The diagram, table and this discussion are meant to help illustrate and explain some of the difficulties associated with prostate cancer staging. First, clinical staging in the absence of pathology reports of the prostate gland is frequently inaccurate. One study found that 66% of clinical stages were upgraded (worsened) after pathologic examination. Information given in Table 1 shows the need for pathological staging. Clinical staging often involves guesswork. This has particular importance for us in underwriting as external radiation therapy, brachytherapy and watchful waiting gain in popularity.
Next, there is the problem of 2 different staging classifications. The American Urological Association established he modified Whitmore-Jewett A through D staging system. For consistency with other cancers, the American Joint Committee on Cancer (AJCC) recommends use of the TNM system. T1 equates with stage A, T2 with stage B, and T3 and T4 with stage C. Table 1 compares the 2 classifications
Download full Journal