How do you reconcile discrepancies in clinical prostate cancer staging with AJCC and NCCN?

Fundamentally, I use NCCN risk categories to help steer conversations about staging and treatment options for very low vs low vs fav int vs unfav int vs high risk diseases. Therefore, I use NCCN staging in my clinical practice and notes and incorporate mpMRI into staging. I find it comforting that N...

I don’t. I use the Gleason score, PSA, T stage, PSMA PET when appropriate, MSKCC and Briganti nomograms, and medical comorbidities to guide recommendations.

This is a common question that, unfortunately, there is not a super simple answer if getting to the core of it.

What is the goal of AJCC? Risk stratification with standardized risk groups. It in no way is meant to guide treatment itself. Unfortunately, the AJCC 8th edition was made solely by 'expert ...

I generally do not use MRI for clinical staging, though with exceptions for very discordant and aggressive findings. Mostly I view MRI findings like Decipher -- a useful tool in risk stratification without actually changing risk groups. For example, consider a patient w/ PSA 11, DRE negative, Gleaso...

There are two somewhat separate issues at play - staging and assessment of the cancer for the purpose of individual patient recommendation. Staging allows us to roughly organize patients into groups for a variety of purposes including making treatment recommendations but also for research and admini...

My first thought upon reading this was, "This is an excellent example of the importance of clinical judgment!"

Similar to armed conflict, where the weapons are often initially way ahead of the tactics, the rapid and continuing evolution of advanced imaging and molecular analysis is moving beyond our...

The understanding of some of the limitations of DRE, and its inter-rater reliability, is evolving. It may be appropriate to update this discussion in light of the recently published 2024 Advanced Prostate Cancer Consensus Conference (APCCC) paper, where 96% of panelists voted in favor of using mpMRI...

While NCCN may allow for T3a to be defined by MRI, traditional risk-stratification (such as NCCN risk groups) did not, and the same story with historical recurrence risk nomograms, such as the MSKCC pre-prostatectomy nomogram, which is critical in my ability to counsel unresected patients who are de...