Clinical versus pathological staging in prostate cancer: insights from a retrospective cohort study

Abstract Background Prostate cancer (PCa) is the most commonly diagnosed cancer in men worldwide. This cohort study evaluates agreement between clinical and pathological T and N staging in PCa, examining patterns of understaging and overstaging and associated clinical factors. Method This retrospective study included 97 patients who underwent radical prostatectomy at King Hussein Cancer Center (2006–2021). Data collected included age, diagnosis date, PSA, clinical and pathological T and N stages, Gleason score, PI-RADS score, lesion characteristics, extracapsular extension, and prostate volume. Concordance between clinical and pathological staging was assessed, and associations with clinical and radiological predictors were analyzed. Patients were categorized as correctly staged, understaged, or overstaged for T stage; only clinical understaging was observed for N stage. Analyses were performed using IBM SPSS Statistics 26.0. Results Ninety-seven patients (mean age 67.7 years; mean PSA 20.9 ng/mL) were included. Clinical and pathological T staging agreed in 61.9% of cases, with 28.9% understaged and 9.3% overstaged (κ = 0.41, p < 0.001). N-stage concordance was 94.8%, with 5.2% understaging (κ = 0.79, p < 0.001). In exploratory regression analysis, larger prostate volume was associated with both T-stage understaging (OR = 1.04, p = 0.04) and overstaging (OR = 1.06, p = 0.04), while PSA, lesion size, Gleason grade, and PI-RADS score were not significantly associated with T-stage discrepancy. Given the small number of N-stage discrepancies, predictor analysis was not performed. Conclusion Clinical and pathological concordance was fair for T stage and substantial for N stage. T-stage discrepancies were linked to larger prostate volume and cT3b status, while N-stage errors were rare and limited to understaging. Improved standardization and advanced imaging may enhance staging accuracy in prostate cancer.