Is subclassification of stage T2 disease still relevant?

There are three pathological subclassifications of prostate cancer that is confined to the prostate: T2a disease (cancer confined to one half of either the left or right lobe or side of the prostate), T2b disease (cancer that is found throughout one lobe or side of the prostate) and T2c disease (cancer that is evident in both lobes or sides of the prostate). Historically, it has been considered that these stages of organ-confined prostate cancer are “different”with respect to risk for progression. However, new data suggests that this may not actually be the case.

Kordan et al. attempted to assess whether substages of pathological T2 prostate cancer predict intermediate term biochemical recurrence-free survival.

They examined data from men who had a radical prostatectomy between January 2000 and June 2008, and who had pathological T2 disease (pT2) at final pathological evaluation. They excluded from their analysis any patient who had had prior treatment, any patient for whom there was < 6 months of follow-up, and any patient for whom other relevant data were missing. This left them with a total of 1,370 patients available for analysis, including 340 with pT2a, 35 with pT2b, and 995 with pT2c disease.

The results of the study then showed the following:

  • Median follow-up was 21 months.
  • No differences were seen in the likelihood of biochemical recurrence-free survival between T2 subclasses (p = 0.174).
  • No patient with T2b disease had recurrence.
  • For patients with T2a disease, the 3- and 5-year likelihoods of freedom from biochemical recurrence were 95.5  and 93.8 percent, respectively.
  • For patients with T2c disease, the 3- and 5-year likelihoods of freedom from biochemical recurrence were 94.3 and 87.5 percent, respectively.
  • Significant predictors of biochemical recurrence-free survival were margin status (p = 0.006), preoperative PSA level (p = 0.029), pathological Gleason score 7 (p = 0.024), and pathological Gleason score 8-10 (p < 0.001).
  • Compared to pathological stage T2a, neither pT2b nor pT2c stages predicted biochemical recurrence-free survival (p = 0.99 and 0.42, respectively).

The authors conclude that “Current pT2 prostate cancer substages may not have prognostic significance for intermediate term outcomes.”

The “New” Prostate Cancer InfoLink  tends to agree with the authors’ additional comment that, if longer follow-up of this patient series and additional studies confirm the current data, “future staging systems may collapse the substages into a single category.” However, we would emphasize that it will take some time for any significant change in pathological staging to move into general clinical practice — even if such a change is established.

One Response

  1. Comment:

    First, it is important to note that we are talking about pathological stage and not clinical staging.

    Second, I would suggest to you that in non-formal intra-medical conversations, the disease is most often referred to as simply T1, T2, T3 and T4 rather than the extended sub-categories, unless it is thought that the further breakdown has real significance, in relation to other factors.

    Third, in a disease that has the extended time-frame progression of prostate cancer, a median of 21 months seems to be exceptionally short on which to base any concrete conclusions.

    Fourth, without the sub-definitions, more delineated research results would be less available in the literature, [making] study result comparisons more difficult.

    The TNM staging system was instituted in a declared attempt to further separate characteristic differences from the much more broadly defined, A, B, C and D definitions used in the previously popular Jewett System.

    Since MEANINGFUL research is so badly needed in the field of prostate cancer, even the suggestion that this study’s data would justify altering the present TNM staging categories, is probably grossly premature in my opinion. – (aka) az4peaks

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