[TNM-Classification of localized prostate cancer : The clinical T-category does not correspond to the required demands].
BACKGROUND
The TNM staging system for localized prostate cancer (PCa) divides tumors based on clinical parameters into a clinical (c)T category and, after radical prostatectomy (RP), a pathological (p)T category.


OBJECTIVE
This study examines the extent to which the cT and the pT category correspond to each other and whether the two categories differ in their prediction for organ-confined disease.


METHODS
Data of 687 RP patients were collected in a prospective, noninterventional, multicenter health service research study for the treatment of localized PCa (HAROW). Group comparisons were performed by analysis of variance and student t‑test as well as the chi-squared test or the Fisher exact test.


RESULTS
Clinical cT1 category (62.9%) and pathological pT2c category (56.6%) were diagnosed most frequently. The correspondence of cT and pT category was 15% for cT2a , 10.5% for cT2b, and 55% for cT2c. An extraprostatic extension (≥pT3) was observed for the categories cT1 and cT2 in 23.5% and 36.4% (p < 0.001), differences in the subcategories cT2a-c were not significant: cT2a = 28.8%, cT2b = 42.1%, and cT2c = 38.8% (p = 0.194). Tumors with a pathologically extraprostatic extension were not recognized clinically in >50%.


CONCLUSIONS
For localized PCa there is low agreement between clinical and pathologic T category, thus, often leading to understaging. An adaptation of the T classification of the TNM system with division into "not palpable" and "palpable" appears sufficient for a prognostic prediction.
Klinik und Poliklinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland. jan.herden@uk-koeln.de.
J
J
Herden
Klinik und Poliklinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
A
A
Heidenreich
Stiftung Männergesundheit, Berlin, Deutschland.
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L
Weißbach
D000368:Aged; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000592:standards*; D011471:Prostatic Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
Digital rectal examination; HAROW-Study; Health service research; Prostate cancer; TNM-staging system