Subclassification of Clinical Stage T1 Prostate Cancer: Impact on Biochemical Recurrence Following Radical Prostatectomy

No AccessJournal of UrologyAdult urology1 Oct 2007Subclassification of Clinical Stage T1 Prostate Cancer: Impact on Biochemical Recurrence Following Radical Prostatectomy Ahmed Magheli, Soroush Rais-Bahrami, H. Ballentine Carter, Hugh J. Peck, Jonathan I. Epstein, and Mark L. Gonzalgo Ahmed MagheliAhmed Magheli Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Urology, Marienhospital Herne, Herne, Germany More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author , H. Ballentine CarterH. Ballentine Carter Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author , Hugh J. PeckHugh J. Peck Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author , Jonathan I. EpsteinJonathan I. Epstein Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author , and Mark L. GonzalgoMark L. Gonzalgo Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.05.153AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We investigated biochemical outcomes following radical prostatectomy across subclassifications of clinical stage T1 prostate cancer. Material and Methods: Of 8,658 men who underwent radical prostatectomy for clinical stage T1 prostate cancer 85, 156 and 8,417 had clinical stage T1a, T1b and T1c disease, respectively. Age, race, prostate specific antigen, year of surgery and preoperative Gleason scores were compared across clinical stage T1 subcategories. Time to prostate specific antigen recurrence was compared among groups using Kaplan-Meier and Cox hazards modeling. Results: Patients with clinical stage T1a prostate cancer had more favorable postoperative pathological features, including lower prostatectomy Gleason scores (p <0.001), rates of extraprostatic extension (p <0.001), lymph node invasion (p <0.001) and positive surgical margins (p = 0.006). Patients with T1a cancer also showed significantly lower rates of biochemical recurrence on Kaplan-Meier analysis than men with T1b and T1c disease (log rank 0.006). Cox regression analysis adjusted for known predictors of biochemical recurrence demonstrated that clinical tumor stage in the subgroup of patients with T1 disease was not an independent predictor of biochemical recurrence (p = 0.321). Conclusions: Men with clinical stage T1a prostate cancer who undergo radical prostatectomy have significantly lower biochemical recurrence rates than men with stage T1b or T1c disease. However, subclassification of tumors in this group of patients was not an independent prognostic factor for biochemical recurrence after accounting for preoperative variables, including prostate specific antigen and Gleason score. References 1 : Proceedings: diagnosis and staging of prostatic carcinoma. Cancer1973; 32: 1096. Google Scholar 2 : Incidental carcinoma of the prostate: a review of the literature and critical reappraisal of classification. J Urol1980; 124: 626. Link, Google Scholar 3 : Trends in patterns of care for prostatic cancer, 1974–1983: results of surveys by the American College of Surgeons. J Urol1986; 136: 416. Link, Google Scholar 4 : Early detection of prostate cancer. Urol Clin North Am1989; 16: 635. Google Scholar 5 : Stage T1A carcinoma of prostate. Urology1994; 43: 11. Google Scholar 6 : The present status of radical prostatectomy for stages A and B prostatic cancer. Urol Clin North Am1975; 2: 105. Google Scholar 7 : Pathological factors that influence prognosis in stage A prostatic cancer: the influence of extent versus grade. J Urol1981; 125: 516. Link, Google Scholar 8 : Prognosis of untreated stage A1 prostatic carcinoma: a study of 94 cases with extended followup. J Urol1986; 136: 837. Link, Google Scholar 9 : Long-term followup of young patients with stage A adenocarcinoma of the prostate. J Urol1986; 136: 840. Link, Google Scholar 10 : The predictive significance of substaging stage A prostate cancer (A1 versus A2) for volume and grade of total cancer in the prostate. J Urol1992; 147: 858. Link, Google Scholar 11 : Can stage A1 tumor extent be predicted by transurethral resection tumor volume, per cent or grade?: A study of 64 stage A1 radical prostatectomies with comparison to prostates removed for stages A2 and B disease. J Urol1991; 146: 1059. Abstract, Google Scholar 12 : Is tumor volume an independent predictor of progression following radical prostatectomy?: A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with 5 years of followup. J Urol1993; 149: 1478. Abstract, Google Scholar 13 : Cancer volume and site of origin of adenocarcinoma in the prostate: relationship to local and distant spread. Hum Pathol1992; 23: 258. Google Scholar 14 : The medical management of lower urinary tract symptoms and benign prostatic hyperplasia. Urol Clin North Am1998; 25: 555. Google Scholar 15 : Treatment choice for benign prostatic hyperplasia: a matter of urologist preference?. J Urol1999; 161: 133. Link, Google Scholar 16 : Assessing the risk of unsuspected prostate cancer in patients with benign prostatic hypertrophy: a 13-year retrospective study of the incidence and natural history of T1a-T1b prostate cancers. BJU Int1999; 84: 1015. Google Scholar 17 : Predictors of cancer progression in T1a prostate adenocarcinoma. Cancer1999; 85: 1300. Google Scholar © 2007 by American Urological AssociationFiguresReferencesRelatedDetails Volume 178Issue 4October 2007Page: 1277-1281 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsprostatectomyneoplasm stagingprostatic neoplasmsprostateMetricsAuthor Information Ahmed Magheli Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Urology, Marienhospital Herne, Herne, Germany More articles by this author Soroush Rais-Bahrami Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author H. Ballentine Carter Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Hugh J. Peck Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Jonathan I. Epstein Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Mark L. Gonzalgo Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...