PATHOLOGY

A clinicopathologic comparison of clinical stages T1c versus T2 prostate adenocarcinoma: lack of differences in PSA recurrence
Armatys S, Koch MO, Bihrle R, Gardner TA, Eble JN, Patel NB, Daggy JB, Cheng L
Indiana University School of Medicine, Indianapolis, Indiana, USA
Mod Pathol. 2004; 17 (suppl.1): 138A

• Background: The current staging system places men with tumors detected because of elevated prostate-specific 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.
  
  
• Editorial Comment
  Tumor found in one or both lobes by needle biopsy, but not palpable or visible by imaging, is classified as T1c. This is a clinical category in the TNM system corresponding to several pathologic findings in the specimen of radical prostatectomy. The study showed that clinical stage T2 tumors have higher Gleason score and final pathologic stage compared to those tumors detected because of elevated serum PSA (T1c), however and most importantly, the PSA recurrence rate for T1c tumors is similar to clinical T2 tumors. The TNM system stratifies prostate carcinoma according to prognosis as evaluated by biochemical recurrence and/or metastases. Based on their findings the authors suggest a further refinement of clinical staging system probably including T1c in the T2 category.
  Recently we classified in our Institution 51 stage T1c patients and 104 clinical T2 patients according to the pathologic findings of the radical prostatectomy specimen. The findings were classified as corresponding to minimal, moderate or advanced tumor according to the study published by Epstein et al. (JAMA. 1994; 271: 368-374). The distribution for stage T1c was 19.69%, 60.78% and 19.69% surgical specimens in the categories limited tumor, moderate tumor and advanced tumor respectively; and, for clinical stage T2, 9.61%, 62.5% and 27.9% respectively for the same categories. The statistical analysis did not show significant difference between these two stages (p = 0.165). Our findings also favor a further refinement of clinical staging system.

Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil