Prostate Cancer Staging Can't Predict Recurrence
Study Shows Difficulties in Estimating Cancer Recurrence After Prostate Is Removed
Predicting Prostate Cancer Recurrence continued...
“We don’t have a good way of staging localized prostate cancer,” says Reza Ghavamian, MD, director of the prostate cancer program at the Montefiore-Einstein Center for Cancer Care and director of urologic oncology and robotic urology at Montefiore Medical Center in New York.
“There are more important predictors of prostate cancer outcome including PSA level, Gleason score, and positive biopsy samples,” he says.
Clinical stage is still important for prostate cancers that have spread outside of the prostate gland, he tells WebMD.
“Some patients say, ‘What stage am I?’ and we usually tell them that they have local disease or that their chances of a spreading cancer are such and such,” he says.
Imaging of Prostate
One of the issues with staging is the lack of a good way to capture images of the prostate, he says.
“Ultrasounds are not a very accurate way of visualizing the prostate,” he says. “You can’t do an ultrasound and say ‘you have prostate cancer,’” he says. Most urologists use transrectal ultrasound to direct the needle during biopsy, he says.
Digital rectal exams (DRE) are also very subjective, he says. During a DRE, your doctor uses a finger to feel for lumps or enlarged areas that could suggest prostate cancer. “Some doctors may feel something subtle and some may not,” he says. “These tests are subject to tremendous intraobserver variability and the assignment of clinical stage is fraught with difficulty.”
American Cancer Society Chief Medical Officer Otis W. Brawley, MD, says it can be hard to determine which localized prostate cancers will recur. “There are some small localized prostate cancers where some of the disease has already broken off and moved outside the body to the bones, and there are some large localized prostate cancers where some of the disease has not moved off to bone and will never move off to bone and cause harm,” he says.
The issue is that doctors don’t know how to predict which way the tumors will go, he says.
What is really needed is a genetic screening test that can tell whether or not this tumor is likely to spread or stay put, he says.