Pathology

Abstract

Background: The current staging system places men with tumors detected because of elevated prostatespecific antigen in the T1 group and those with palpable localized prostate cancer in T2. To test the hypothesis that these patients have similar outcomes and other clinicopathologic features and should be grouped together, we studied a series of 291 patients with cT1c and cT2 prostate cancers.Design: From a series of 288 consecutive patients who underwent radical retropubic prostatectomy, we studied those with cT1c (n = 223) and cT2 (n = 65) adenocarcinoma. All specimens were totally embedded and whole-mounted. Tumor volume was measured using the grid method. Clinical and pathologic characteristics were analyzed.Results: Patients with cT2 tumors were more likely to have a higher Gleason score (P = 0.04) and final pathologic stage (P = 0.05), compared to those with T1c tumors. There was no significant difference in age (P = 0.92), preoperative PSA (P = 0.17), prostate weight (P = 0.34), tumor volume (P = 0.16), the largest tumor size (P = 0.12), surgical margin status (P = 0.86) or the presence of perineural invasion (P = 0.09) between patients with clinical stage T1c tumors and those with cT2 tumors. No difference in PSA recurrence was observed between patients with clinical stage T1c tumors and those with cT2 tumors (P = 0.20).Conclusions: Patients with clinical stage T2 tumors have higher Gleason score and final pathologic stage compared to those tumors detected because of elevated serum PSA (T1c). However, the PSA recurrence rate for T1c tumors is similar to cT2 tumors, indicating a need for further refinement of clinical staging system.