Prostate cancer collaborative stage data items—their definitions, quality, usage, and clinical implications: A review of SEER data for 2004‐2010

Abstract

BACKGROUND: Version 2 of the Collaborative Stage Data Collection System (CSv2) became effective with cases diagnosed in 2010. This report focuses on the CSv2 components required to derive the American Joint Committee on Cancer (AJCC) stage for prostate cancer and on the site-specific factors for prostate cancer captured in CSv2. The report also highlights differences between the AJCC 6th and 7th editions for classifying prostate cancer stage. METHODS: Data from 18 Surveillance, Epidemiology, and End Results (SEER) Program population-based registries (SEER-18) were analyzed for the years 2004-2010, which included 400,591 prostate cancer cases. RESULTS: CSv2 provides specificity with regard to the Gleason grading system by distinguishing between clinical and pathologic patterns and scores. The AJCC 7th edition incorporates prostate-specific antigen values into staging, subdivides stage II into IIA and IIB, and reclassifies extraprostatic invasion with microscopic bladder neck invasion from T4 in the 6th edition to T3a; this latter change affected the AJCC stage of 283 cases in 2010. Of the 44,578 prostate cancer cases diagnosed in 2010 that would have been classified as stage II in the AJCC 6th edition, 32.7%, 27.5%, and 39.8% are classified as stages I, IIA, and IIB, respectively, in the 7th edition. CONCLUSIONS: CSv2 provides more information than was previously available to researchers using SEER prostate data.

Definition and Validation of “Favorable High-Risk Prostate Cancer”: Implications for Personalizing Treatment of Radiation-Managed Patients

“…We attempted to address this limitation by validating our initial findings in a more general national cohort from the SEER-Medicare database and found very similar results. quality analysis of the SEER database (19), we tried to account for this possible source of error by excluding patients who had discordant PSA values and recorded PSA interpretations (e.g.…”

“…PSA < 4.0 ng/mL recorded as "positive/elevated" or PSA > 4.0 ng/mL recorded as "negative/normal"), giving us a final cohort size of 13,275. This approach to identifying possibly incorrectly coded PSA values was based on the observations of Schymura and colleagues(19). Using Medicare claims data, we determined which patients in the SEER Q2020).…”

Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy

“…Recent criticisms of SEER population data in regard to evaluating outcomes in PCa focus on a lack of granularity as prostate specific metrics, such as PSA and Gleason score, are not available or unreliable. However, the largest shift in stage, seen with the introduction of the AJCC 7 th edition at the beginning of 2010 38 , would lead to an underestimation of the effectiveness of RARP. There have been changes to Gleason score as well over time which has also impacted stage migration within this cohort.…”

Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

“…However, preliminary investiga- tions by the SEER program have determined that only approximately 5% of PSA values led to incorrect classification of PSA category among < 10 ng/ml, 10-20 ng/ml, and > 20 ng/ml. Based on the results of Schymura et al [20], we attempted to account for these erroneous values by removing patients who were listed as having a positive PSA despite PSA < 4 ng/ml or who were listed as having a negative PSA despite PSA > 4 ng/ml; this approach identified 4.6% of patients with possibly incorrect PSA values. Although this approach may not have accounted for all possible errors in PSA values, the relatively low rate of incorrect PSA categorization combined with the likely random nature of these coding errors leads us to believe that these errors are not likely to systematically bias our findings or impact our conclusions.…”