Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

Abstract

Clinical staging criteria for prostate cancer were established before the advent of widespread prostate specific antigen screening and extended biopsy templates. However, clinical stage remains commonly used in the modern era to predict prostate cancer outcomes. We hypothesize that in the context of data available from a contemporary biopsy, clinical stage no longer offers meaningful independent prognostic information for clinically localized prostate cancer. We performed an analysis of men in the CaPSURE database with localized (clinical stage T1 or T2) prostate cancer who underwent radical prostatectomy. The usefulness of clinical stage and other clinical parameters (prostate specific antigen, biopsy Gleason score, percent of positive biopsy cores) to predict pathological outcomes and biochemical recurrence after radical prostatectomy was assessed using univariate and multivariable analyses. Of the 4,899 men in the study cohort 51.9% were classified as having T1 disease and 48.1% T2 disease. On univariate analysis clinical stages T2b and T2c were associated with pathological outcomes but only stage T2b was associated with biochemical recurrence. In contrast prostate specific antigen, biopsy Gleason score and percent of positive biopsy cores were strongly associated with recurrence and adverse pathological outcomes. On multivariable analysis clinical stage was of no use in determining pathological or biochemical outcomes. In a multivariable model, including serum prostate specific antigen, biopsy Gleason score and percent of positive biopsy cores, clinical stage offered no independent information in predicting biochemical recurrence. The results of this study call into question the usefulness of clinical staging criteria in risk stratifying cases of localized prostate cancer treated with radical prostatectomy.