OUTCOME BASED STAGING FOR CLINICALLY LOCALIZED ADENOCARCINOMA OF THE PROSTATE

Purpose: Some patients with clinically localized prostate cancer are n ot cured after radical prostatectomy because of the presence of occult systemic disease. The American Joint Commission on Cancer staging cla ssification for prostate cancer does not reliably distinguish between clinically localized patients who are likely or unlikely to be cured a fter local therapy. This project was undertaken to develop a staging s ystem capable of predicting long-term outcome after radical prostatect omy on the basis of the clinical parameters obtained routinely during the standard workup for patients with adenocarcinoma of the prostate. Materials and Methods: A total of 688 clinically localized prostate ca ncer patients managed with a radical retropubic prostatectomy for aden ocarcinoma of the prostate between 1989 and 1996 was evaluated for cli nical features predictive of time to prostate specific antigen (PSA) f ailure using a Cox regression multivariate analysis, A recently define d clinical factor called the calculated prostate cancer volume and its ability to predict time to PSA failure in conjunction with PSA, biops y Gleason score and clinical stage were evaluated. Results: The calcul ated prostate cancer volume (p < 0.0001) and the pretreatment PSA (p < 0.001) provided the optimal staging system for predicting freedom fro m PSA failure after radical prostatectomy. Conclusions: The calculated prostate cancer volume and PSA may provide clinically useful informat ion regarding outcome after radical prostatectomy, enabling the select ion of a therapeutic approach for an individual patient with clinicall y localized disease. Validation of this staging system is needed.