A new clinical-anatomic staging system for evaluating prognosis and treatment of prostatic cancer

Because the existing systems of staging for prostatic cancer depend exclusively on the extent of anatomic spread, the stages do not demarcate distinctive patterns of survival, particularly in patients with extremely good or poor prognoses. In this research, we demonstrate that the evaluation of prognosis and therapy can be improved if anatomic staging is augmented by various features of the patients' clinical severity. In 280 patients with prostatic cancer, we first created rating scales for severity of three distinct clinical variables: symptoms referable to cancer; host factors unrelated to cancer; and overall level of function. In univariate analysis each of these clinical variables substantially affected 5-year survival for patients with similar anatomic stages, but in multivariate analysis, only the first two (symptoms and host factors) remained impressive. Retaining the anatomic stages and adding the two most important clinical variables, we then created a composite new staging system, containing four clinical-anatomic (C-A) categories. The new C-A categories were statistically more distinctive than conventional anatomic stages, and demarcated patients with more extreme high (91%) and low (8%) 5-year survival rates. In addition to the increased prognostic precision, the new C-A staging system demonstrated an important distinction in treatment. Although radical radiotherapy seemed superior to palliative therapy within conventional anatomic stages, the survival differences disappeared within the C-A stages.