Prostate cancer pathologic stage pT2b (2002 TNM staging system): does it exist?

Quintal, Maisa M. Q.; Magna, Luís Alberto; Guimarães, Marbele Santos; Ruano, Thais; Ferreira, Ubirajara; Billis, Athanase

doi:10.1590/s1677-55382006000100007

Cited by 18 publications

(6 citation statements)

References 13 publications

(11 reference statements)

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“…The same result was reported by others who used a pathological assessment [10,11]. In the first study, RP specimens of 369 patients with prostate cancer were evaluated by complete embedding and whole‐mount processing [10]; no pathological pT2b tumour specimen was found.…”

Section: Discussionsupporting

confidence: 61%

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The prognostic role of the pathological T2 subclassification for prostate cancer in the 2002 Tumour‐Nodes‐Metastasis staging system

Oort¹,

Witjes²,

Kok

et al. 2008

BJU International

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OBJECTIVE To evaluate the prognostic role of the 2002 Tumour‐Nodes‐Metastasis (TNM) pT2 subclassification for biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer. PATIENTS AND METHODS The 1997 TNM staging system is based on one subdivision for organ‐confined prostate tumours (T2a, unilateral; T2b, bilateral involvement). The 2002 TNM staging system subdivides unilateral involvement into T2a (half of one lobe or less) and T2b (more than one half of one lobe), while bilateral involvement is classified as T2c. In all, 542 patients were treated with RP at our institute; the RP specimens were completely embedded and histopathologically evaluated for Gleason grade, tumour volume and anatomical extent, and were staged according to the 2002 TNM staging criteria. Patients were followed for a median of 39.5 months. BCR was defined as two subsequent increasing prostate‐specific antigen (PSA) levels of >0.10 ng/mL. Kaplan‐Meier and proportional hazards regression analyses were used to evaluate the univariable and multivariable prognostic effect of tumour stage. RESULTS According to the 2002 TNM staging system, 360 specimens were found to have pT2 tumours; 79 (22%) of the RP specimens were staged as pT2a and 281 (78%) as pT2c; no pT2b specimens were identified. Patients with unilateral involvement (pT2a) had a 5‐year risk of BCR of 13%, while those with bilateral involvement (pT2c) had a risk of 23% (log rank test, P = 0.056). Patients with pT2c disease were more likely to have a larger tumour volume (Mann–Whitney U‐test P < 0.001) and positive surgical margins (Fishers’ exact test, P = 0.001)than those with pT2a tumours. Mann–Whitney U‐tests showed no differences between the groups for preoperative PSA levels (P = 0.167). Also, the RP Gleason score was no different between groups (Pearson chi‐square, P = 0.807). In the multivariable analyses, positive surgical margins appeared to increase the risk of BCR (hazard ratio 4.4, 95% confidence interval 2.5–7.9); pT2c vs pT2a had only a marginally (insignificant) additional effect (1.3, 0.6–2.7). CONCLUSION The absence of a true unilateral pathological T2b tumour in a series of 360 pT2 RP specimens questions the relevance of substaging unilateral disease. The limited differences in BCR and in pathological features of unilateral vs bilateral pT2 prostate cancer justify modifying the TNM staging system to one with no subclassification of pT2 disease, or at most as only one subdivision into unilateral (T2a) and bilateral (T2b) disease, combining the T2b and T2c substages.

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Section: Discussionsupporting

confidence: 61%

“…The latter study by Quintal et al. [11] used a point‐counting method, i.e. each quadrant of each whole‐mount section was drawn on paper and contained eight equidistant points.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of the pathological T2 subclassification for prostate cancer in the 2002 Tumour‐Nodes‐Metastasis staging system

Oort¹,

Witjes²,

Kok

et al. 2008

BJU International

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“…Also, defining pathological tumour stage according to uni‐ or bilateral lobe involvement may not be optimal for prostate cancer, which frequently present as a multifocal tumour. Moreover, some Western researchers have reported that pT2b prostate cancers (according to the 1992 and the 2002 TNM staging systems) actually do not exist [5,6]. Meanwhile, to our knowledge, the current TNM staging system for prostate cancer has not been evaluated formally in an Asian series of prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of pT2 subdivisions in the TNM staging system for prostate cancer

Hong¹,

Han²,

Chung³

et al. 2008

BJU International

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RESULTSUsing the 2002 TNM staging criteria, 87 of the tumours (23.4%) were pT2a, and 284 (76.3%) were pT2c. Of all subjects, there was only one (0.3%) pathological 2002 T2b tumour identified. When subjects were classified according to the 1997 versions of the T2 subclassification (pT2a vs pT2b), the 1997 pT2a and pT2b cases showed no significant difference regarding BRFS (logrank P = 0.645) among those who were followed-up for > 2 years after RRP. Also, pathological stage (1997 pT2a vs pT2b) was not a significant predictor of BRFS in either uni-or multivariate analysis ( P = 0.289 and P = 0.241, respectively). Only preoperative serum PSA level and pathological Gleason score along with positive surgical margin were significant predictors of PSA outcome after RRP on multivariate analysis. CONCLUSIONOur results suggest that two-or three-tiered subclassification of pT2 organ-confined prostate cancer via methods used in the previous or current TNM staging system may not be appropriate. Efforts should be made to upgrade the current TNM staging system for prostate cancer. KEYWORDSprostate cancer, prostatectomy, TNM staging, pathologic Stage OBJECTIVETo evaluate the subclassifications of pT2 diseases in tumour-nodes-metastases (TNM) staging system for prostate cancer. PATIENTS AND METHODSWe retrospectively analysed the data of 372 patients who underwent radical retropubic prostatectomy (RRP) for pathologically organ-confined prostate cancer at our institution. Pathological staging of all subjects were re-evaluated using the 1997 and the 2002 TNM staging system for prostate cancer. Various clinicopathological features along with biochemical recurrencefree survival (BRFS) of pT2 subgroups were assessed.

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“…Biyokimyasal nüksü öngörmede T2 alt sınıflamasının katkısının değerlendirildiği başka bir çalışmada, ameliyat öncesi PSA ve patolojik Gleason skorunun 7 ve 8-10 olması biyokimyasal nüks bakımından öngörücü iken, patolojik T2 alt gruplarının herhangi bir katkısının olmadığı bulunmuştur. [19] 2002 TNM sınıflamasına göre pT2b tümörlerin saptanma oranı çalışmaların çoğunda çok düşüktür, [20][21][22] hatta bazı çalışmalarda hiç saptanmamıştır. [14] Farklı olarak bir çalışmada prostata sınırlı tümörlerin %61.1'inin pT2b olduğu bulunmuştur.…”

Section: Discussionunclassified

“…Brezilya'dan yapılan bir çalışmada da pT2b tümör saptanmamıştır. [22] Tümör hacminin prognostik önemi konusunda tartışma yoktur, ancak kullanılmakta olan parametrelerin (evre, Gleason skoru, seminal vezikül invazyonu, cerrahi sınır) ek katkı sağlayıp sağlamadığı tartışmalıdır. Katkı sağlamasa da tespit edilmesi önerilebilir.…”

Section: Discussionunclassified

Is substaging necessary in patients with pathological stage T2 prostate cancer?

Soydan¹,

Ateş²,

Küçükodacı³

et al. 2011

Turkish Journal of Urology

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Objective: To determine whether pathological T2 subgroups of prostate cancer can be predicted using preoperative data and to investigate whether there is any difference between pathological T2 subgroups in terms of biochemical recurrence. Materials and methods:Patients who underwent radical prostatectomy in our clinic between 2001 and 2010 and who had a tumor confined to the prostate were classified into pathological T2 subgroups according to the 1992/2002 and 1997 TNM staging system. These patients were compared in terms of clinical stage, preoperative prostate-specific antigen (PSA), biopsy tumor percentage, biopsy and prostatectomy Gleason score, and biochemical recurrence.Results: According to the 1992/200 2 TNM staging system, the clinical stages, biopsy Gleason scores, and tumor size of the pT2 subgroups were different, while the biopsy tumor percentage, preoperative PSA, and prostatectomy Gleason scores of the pT2 subgroups were similar. There was no correlation between biopsy tumor percentage and tumor volume. PSA recurred in 1, 1, and 2 patients in the pT2a, pT2b, and pT2c subgroups, respectively. According to the 1997 TNM classification, the clinical stage, biopsy and prostatectomy Gleason scores, biopsy tumor percentage and preoperative PSA of pT2 subgroups were similar, while the tumor volumes differed among the pT2 subgroups. Conclusion:It is impossible to predict T2 subgroups using preoperative data. There is no difference among groups in terms of the rates of biochemical recurrence. It is not convenient to use the biopsy tumor percentage in order to predict tumor volumes or pathological subgroups.

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Prostate cancer pathologic stage pT2b (2002 TNM staging system): does it exist?

Abstract: Using the point-count method for tumor extent, our study questions a real existence for pathologic stage pT2b tumors (unilateral tumors involving greater than one-half of one lobe).

Cited by 18 publications

References 13 publications

The prognostic role of the pathological T2 subclassification for prostate cancer in the 2002 Tumour‐Nodes‐Metastasis staging system

The prognostic role of the pathological T2 subclassification for prostate cancer in the 2002 Tumour‐Nodes‐Metastasis staging system

Evaluation of pT2 subdivisions in the TNM staging system for prostate cancer

Is substaging necessary in patients with pathological stage T2 prostate cancer?

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