Errors in clinical staging of localized prostate cancer occur frequently, particularly when transrectal ultrasound (TRUS) is used to detect abnormalities, a new study suggests.
The study showed that in more than a third of cases, the cancer staging assignment was incorrect, casting doubt on the utility of a staging system for localized prostate cancer based on digital rectal examination (DRE) and TRUS.
The findings of the study by Adam C. Reese, MD, of the University of California, San Francisco, and his associates appear online in Cancer.
The researchers analyzed data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database on 3875 men with clinical T1 pr T2 stage prostate cancer. Stage determined by DRE/TRUS findings was compared with the clinical stage reported by the patient’s physician.
The clinical stage was assigned incorrectly in 1370 (35.4%) of the 3875 men. The assigned clinical stage was too low in 55.1% of cases and too high in 44.9%. Men whose lesion were detected by TRUS were more likely to be staged incorrectly than those with abnormal findings on DRE (65.8% vs 38.2%).
No association was found between clinical stage and biochemical disease recurrence after radical prostectomy, even after staging errors were corrected.
Biopsy findings were found to influence staging despite the fact this practice is not recommended.