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Mack Roach III, Vivian Weinberg, Howard Sandler and Ian Thompson Staging for prostate cancer Cancer 109

Version of Record online: 13 DEC 2006 | DOI: 10.1002/cncr.22403

The American Joint Committee on Cancer (AJCC) staging system for prostate cancer is based primarily on clinical tumor (T) classification. Men with localized prostate cancer who received treatment with external beam radiation alone were analyzed according to the 1997 AJCC system compared with a system that included prostate-specific antigen (PSA) level and Gleason score (GS). Multivariate analyses using a Cox proportional-hazards model were carried out to evaluate T classification, GS, and pretreatment PSA (pPSA) as predictors of overall survival (OS), disease-specific survival (DSS), and freedom from PSA failure (FFPF). The results indicated the independent statistical significance of T classification, GS, and pPSA in predicting OS, DSS, and FFPF (model chi-square value, P < .0001 for each). Current practice patterns support the argument that AJCC staging should be changed to incorporate pPSA and GS and to incorporate risk stratification.

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