© 2 0 0 5 B J U I N T E R N A T I O N A L | 9 6 , 7 7 7 – 7 8 0 | doi:10.1111/j.1464-410X.2005.05713.x 777 Original Article CLINICAL STAGES T1C vs T2 PROSTATE ADENOCARCINOMA ARMATYS et al. Is it necessary to separate clinical stage T1c from T2 prostate adenocarcinoma? SANDRA A. ARMATYS*, MICHAEL O. KOCH*, RICHARD BIHRLE*, THOMAS A. GARDNER* and LIANG CHENG*† Departments of *Urology and †Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA Accepted for publication 6 May 2005 RESULTS Patients with cT2 tumours were more likely to have a higher Gleason score (P = 0.04) and final pathological stage (P = 0.05) than those with cT1c tumours. There was no significant difference in age (P = 0.92), preoperative PSA level (P = 0.17), prostate weight (P = 0.34), tumour volume (P = 0.16), surgical margin status (P = 0.86), multifocality (P = 0.92), the presence of perineural invasion (P = 0.09), or high-grade prostatic intraepithelial neoplasia (P = 0.99) between patients with clinical stage cT1c and those with cT2 tumours. There was no difference in PSA recurrence between patients with clinical stage T1c and those with cT2 tumours (P = 0.27). CONCLUSIONS Patients with clinical stage cT2 tumours have a higher Gleason score and advanced pathological stage than tumours detected because of a high serum PSA level (cT1c). These results suggest that clinical stage cT1c tumours should be separated from clinical stage cT2 disease, but the PSA recurrence rate for both tumour stages is similar, indicating a need for further evaluation and refinement of the current clinical staging system. KEYWORDS prostate, neoplasm, prostatectomy, staging, prognosis, PSA recurrence. OBJECTIVE To test the hypothesis that prostate cancer patients with clinical stage cT1c and cT2 have similar outcomes and clinicopathological features, and should be grouped together. PATIENTS AND METHODS From a series of men with prostate cancer who had a radical retropubic prostatectomy (RP), we assessed those with cT1c (223) and cT2 (65) adenocarcinoma. All RP specimens were totally embedded and whole-mounted; tumour volume was measured using the grid method. Clinical and pathological characteristics were analysed. INTRODUCTION The use of PSA screening has significantly increased the number of patients with prostate cancer who are detected at an earlier stage, but the data to suggest whether there is a survival advantage over the use of a DRE alone is not conclusive. The current TNM staging system, which aids in determining the prognosis, suggests that there is a survival advantage in patients with prostate cancer detected by PSA screening. Recent studies suggest that the clinical outcome between prostate adenocarcinoma detected by PSA screening (cT1c) or disease detected on a DRE (cT2) may have the same prognosis after treatment [1]. In the present study, we compared the clinicopathological characteristics of a contemporary series of patients who had a radical retropubic prostatectomy (RRP) and subsequent whole-mount specimen processing for cT1c and cT2 adenocarcinoma of the prostate. PATIENTS AND METHODS The study population comprised 288 men who had a RRP between 1999 and 2003 at Indiana University Medical Center. Patients who received preoperative adjuvant therapy were excluded. Patients had a preoperative abdominal CT, a bone scan and a chest X-ray, based on clinical circumstance and preoperative PSA level. No patients with evidence of metastatic disease had a RRP. The patients were clinically staged using the 2002 TNM system [2]. Serum PSA concentration was measured using the Immulite ® PSA assay (Diagnostics Products Corporation, Los Angeles, CA). PSA recurrence was defined as a serum PSA level of ≥0.1 ng/mL after surgery [3–5]. The patients were followed at 1, 3, 6, 12, 18 and 24 months during the first 2 years; thereafter the follow-up was adjusted according to the clinical situation, but was at least annual. The RP specimens were examined as previously described [6–9]; the prostates were weighed, measured, inked and fixed in 10% neutral formalin. After fixation the apex and base were amputated and serially sectioned at 3–5 mm intervals in the vertical, parasagittal plane. The seminal vesicles were sectioned parallel to their junction with the prostate and entirely submitted for examination. The remaining prostate was serially sectioned perpendicular to the long axis from the apex of the prostate to the base, and whole-mount sections prepared. The volume of carcinoma in the entire prostate was determined by the grid method, and was the sum of the volumes of individual foci of tumour [10–13]. Perineural invasion was assessed using the established criteria [14]; it typically occurred in the peripheral zone of the prostate and can be located within the prostatic parenchyma, at both the capsular and extracapsular levels. Pathological stage was assessed according to the 2002 TNM criteria [2], and tumours were classified as either T2 or T3 for the purposes of statistical analysis. In our previous study, we found that a true pT2b tumour probably does not exist [15]. Gleason score was determined according to the Gleason grading system [16– 18]. All pathological data were collected prospectively by one genitourinary pathologist (L.C.). The Spearman coefficient of rank correlation was calculated for variables including age, preoperative PSA level, prostate weight,