Evaluation of the Patient With Prostate Cancer

Ashutosh Tewari, MD, MCh, Badrinath Konety, MD, Akshay Bhandari, MD, James Peabody, MD, Hans Stricker MD, Christine Johnson, PhD, Raymond Demers, MPH, Mani Menon, MD, FACS, the Josephine Ford Cancer Center and Department of Urology, Henry Ford Health System, Detroit, Michigan.

In This Article


Prostate cancer is one of the most common cancers in men, comprising approximately 29% of all cancers. Last year, about 180,000 new diagnoses of prostate cancer were made in the United States.[1] Only those cancers that are truly organ confined are potentially curable by surgery or radiation. All others usually defy any curative intent. The determination of organ confinement is called staging, which serves as a blueprint for planning treatment. Management significantly differs according to stage of disease. Inaccuracies in staging can result in inappropriate management and incorrect prediction of prognosis. This, in turn, leads to poor treatment selection; exposure to unwarranted complications such as pain, impotence, and incontinence; patient frustration; and cost escalation due to extra investigations and multiple treatments such as postoperative radiation therapy.[1]

Staging, according to the tumor, node, and metastasis [TNM] system,[2,3] traditionally implies quantification of the locoregional and systemic spread of the cancer. In order to be of prognostic use, however, staging should also permit assessment of biological behavior of the tumor. The need for staging to provide this information is mainly due to a wide variation in the natural history of prostate cancer. This is so because some patients with prostate cancer die from the cancer, while others can live with the cancer for a long time and die from other causes. Mere estimation of locoregional extent of cancer is unlikely to differentiate between these 2 disease courses, which result from varying biological behavior. A comprehensive evaluation model is needed that incorporates information such as extent of cancer, Gleason grade/score, biological activity, surrogate measures of tumor volume based on biopsy results (percent of cancer and number of positive biopsies) and biomarkers of progression. Such an approach provides a unified estimation of prognosis and of locoregional extent of the disease.[4,5]

In this article, we will review the current knowledge on staging of patients with prostate cancer. Special emphasis will be put on comprehensive models relying on preoperative parameters to determine probability of pathological stage and prognosis following treatment. Presentation of these models will be accompanied by a discussion on their validity.


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