Health News and Information

Clinical Stage versus Pathologic Stage

This can be pretty confusing. Clinical stage is an estimate, what a doctor believes a man’s prostate cancer to be, based on factors such as the digital rectal exam, PSA, transrectal ultrasound and needle biopsy. Pathologic stage is much more certain—and, for predicting the likelihood for cure, it’s essential— because a pathologist has been able to examine actual prostate tissue and, often, tissue from the lymph nodes, not just make guesses about it based on a few cells and test results. Until recently, knowing pathologic stage was only possible when the prostate was removed. Now, however, based on table 3.3, doctors have a much better way of estimating a man’s pathologic stage of cancer before surgery.

More on the Digital Rectal Exam and Staging

Like transrectal ultrasound, the digital rectal exam is not able to pick up microscopic cancer spread to the prostate wall and beyond. Because of this, the digital rectal exam tends to underestimate the stage of cancer. Studies have found that a significant number of cancers initially staged as T2b (Bi) end up being classified as higher because of cancer that has invaded the capsule of the prostate or the seminal vesicles. For cancer with an initial clinical evaluation of T2c (B2), this degree of “understaging” ranges from 39 percent to 66 percent. One reason for this is that the digital rectal exam is subjective; it depends on the experience and perceptiveness of the doctor performing it. Another is that the digital rectal exam can only give information about the prostate gland itself— and not even all of it, at that. And it certainly can’t tell anything about the nearby pelvic lymph nodes or bones. Also, if a man has had other treatment of a prostate disorder—a TUR, for instance, for BPH—this can cause the prostate to feel different on an exam, and it can throw off the digital rectal exam.

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