Imaging for staging prostate cancer--too much or not enough?

摘要

The clinical staging of prostate cancer is appropriately accomplished using the TNM system, which relies heavily on digital rectal examination and, to a lesser extent, transrectal ultrasound findings. However, in patients with clinically localized prostate cancer, current clinical staging paradigms may not be predictive of disease recurrence after treatment.1 This has been attributed to an inherent weakness in staging methods as well as the improper assignment of clinical T stage by practitioners.1 In a study of the CaPSURE? database to evaluate clinical staging in 3,875 men with clinically localized (cTlc-cT2) disease inaccuracies were revealed in 35%.2 Inappropriate down staging accounted for 55% of these errors. Of the men who had bilateral digital rectal examination and/or transrectal ultrasound lesions and a unilateral positive biopsy 89% had disease erroneously classified as cT2a/b instead of cT2c, which may have had direct implications on treatment options.