Pathologic T2 Stage Subgroups And Recurrence-Free Survival After Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 31 Jul 2008 - 4:00 PDT

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UroToday.com - In the online version of Urology, Dr. James McKiernan and a group of investigators at Columbia University reported that while clinical subgroups of stage cT2 prostate cancer (CaP) have prognostic significance, pathologic subgroups of stage pT2 do not.

In 1997, the American Joint Committee on Cancer (AJCC) eliminated the stage cT2 sub-staging, based upon the degree of prostatic lobar involvement. T2a was classified as unilobar, and T2 as bilobar disease. However, reports then suggested prognostic significance to the degree of lobar involvement, and in 2002 the sub-stages were reestablished as T2a (less than 50% lobar involvement), T2b (greater than 50% lobar involvement), or T2c (bilobar involvement). The present report evaluated whether the subcategories of pathologic T2 staging after radical prostatectomy (RP) are predictive of recurrence-free survival (RFS).

Between 1990 and 2004, 906 men who had RP with pT2 CaP met inclusion criteria. The primary endpoint was PSA recurrence as defined by a PSA of 0.2ng/ml or greater. Mean patient age was 61 years, and median follow-up was 58 months. Preoperatively, 51% had cT1 and 45% had cT2 staging. Preoperative PSA was not different between sub-stages, although Gleason score was lower in the pT2a group. On final pathology, 98 men (10.8%) had pT2a CaP, 76 (8.4%) had pT2b disease and 732 (80.8%) had pT2c disease.

At last follow-up, 95% of both the pT2a and pT2b groups had no evidence of disease. While no man in the pT2a group died of CaP, 2 in the pT2b group did, and one in the pT2c group did. Among pT2c patients 89% exhibited no evidence of disease at last follow-up, which did not statistically differ from the other groups. In multivariate analyses, Gleason score 7 or higher and preoperative PSA >10ng/ml were both associated with increased risk of CaP recurrence. A statistically significant difference in CaP recurrence was not found between pT2a, pT2b and pT2c groups in the multivariate analysis. Overall recurrence-free survival at 5 and 10 years for pT2 CaP was 90% and 72.5%, respectively.

Decastro GJ, McCann T, Benson MC, McKiernan JM
Urology. 2008 Jul 1. Epub ahead of print.
doi:10.1016/j.urology.2008.01.054

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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