Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: implications for unilateral ablative therapy.
BACKGROUND
Early detection of small volume prostate cancer (PCa) has led to the concept of focal therapy to treat in an organ-sparing manner. We evaluated trends in pathologic staging among patients with localized PCa undergoing radical prostatectomy (RP), defining the frequency of unilateral cancers during 1988-1995, 1996-2000 and 2001-2006.


METHODS
Data were abstracted from the Duke Prostate Cancer Outcome database selecting 3,676 men with available pathology treated with RP. Based on surgical pathology, trends in as pathological T (pT) stage, pathological Gleason Score (pGS), and percent tumor involvement (PTI) were evaluated.


RESULTS
pT2a increased from 2.8% of men undergoing RP in 1988-1995 to 13.0% during 2001-2006 (P < 0.0005). PTI analysis shifted towards low volume disease, e.g. PTI <or= 5% increased from 10% during 1988-1995, to 37% in 2001-2006 (P < 0.005). Of all pT2a disease throughout 1988-2006, an increase in proportion of pT2a tumors from 10% during 1988-1995 to 69.4% during 2001-2006 was identified. Over three eras, pT2a had minimal (65% had PTI <or= 5%) or small volume (14% had PTI 5.01-10.00) disease, and 59% were low grade (pGS <or= 6). Using a Cox Hazard model, pT2a versus pT2b disease, surgical margins, PTI, and PSA statistically contributed to PSA disease-free survival in the contemporary era 2001-2006.


CONCLUSIONS
The increasing prevalence of unilateral pT2a/T2b PCa characterizes a growing proportion of men recently electing RP. These tumors are associated with lower PTI, pGS <or= 7, and demonstrated better PSA-free survival in the 2001-2006 era. These low risk pathologic characteristics may allow for unilateral focal therapy in carefully selected patients.
Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. polas001@mc.duke.edu
Thomas J
TJ
Polascik
Janice M
JM
Mayes
Leon
L
Sun
John F
JF
Madden
Judd W
JW
Moul
Vladimir
V
Mouraviev
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000639:trends*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen