Cancer Research Lab

The current American Joint Committee on Cancer (AJCC) staging system for prostate cancer does not incorporate tumor classification, pretreatment prostate specific antigen (pPSA) level or Gleason score (GS) and therefore does not include information that is needed to make decisions on appropriate treatment options, according to investigators writing in the January 15th issue of Cancer.

Dr. Mack Roach of the University of California at San Francisco and colleagues used multivariate analyses to create a Cox proportional hazards model in 912 men with localized prostate cancer who had received external beam radiation therapy between 1987 and 1998.

The investigators compared the AJCC staging system with a system that also incorporated these five additional factors: pPSA; GS; tumor classification; overall survival; disease-specific survival; and freedom from PSA failure.

Only 0.6% of contemporary patients, incorporating the additional five predictors, were classified with AJCC stage I prostate cancer, 83.4% were classified with AJC stage II and 16.0% are classified with AJCC class III disease.

The researchers write that “there is now a compelling body of evidence to support the notion that pPSA and GS should now move beyond risk-stratification systems and also should be incorporated into our staging system.”

Dr. Roach said that the primary weakness of the current staging system is that “it does not include PSA, and does not incorporate the tumor grade (Gleason score) the way clinicians use it. Most patients fall into a broad category (and the current staging system) does not predict outcome very accurately.”