Men with clinical stage T2c (cT2c) prostate cancer (PCa) should be considered at intermediate risk of biochemical recurrence after radical prostatectomy if other high-risk factors are absent, according to a new study.

Study findings suggest that patients with cT2c disease should be counseled appropriately and offered treatment options for intermediate-risk disease, concluded a research team led by Stephen J. Freedland, MD, of Duke University Medical Center in Durham, N.C.

Dr. Freedland and his colleagues examined whether cT2c tumors without other high-risk factors (cT2c not otherwise specified [NOS]) behaved as an intermediate- or high-risk cancer though an analysis of biochemical recurrence (BCR) after radical prostatectomy (RP). Their study included 2,759 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) database and 12,900 men from Johns Hopkins Hospital (JHH) in Baltimore.

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A total of 99 men from SEARCH (4%) and 202 from JHH (2%) had tumors classified as cT2c-NOS. The cT2c-NOS patients had BCR rates similar to that of the intermediate-risk patients, Dr. Freedland’s group reported online ahead of print in Cancer. During a median follow-up of 66 months in the SEARCH cohort, 37% of cT2c-NOS patients and 40% of intermediate-risk patients experienced BCR. During a median follow-up of 48 months in the JHH cohort, 30% of cT2c-NOS patients and 21% of intermediate-risk patients experienced BCR.

In multivariate analysis, men with cT2c-NOS tumors did not differ significantly in BCR risk from those with intermediate-risk tumors in either cohort, but they had a significantly lower risk of BCR than men with high-risk disease. Men in the SEARCH cohort with cT2c-NOS disease had a 41% decreased risk of BCR compared with high-risk men. In the JHH cohort, men with cT2c-NOS disease had a 61% decreased risk of BCR compared with high-risk men. 

The investigators noted that the National Comprehensive Cancer Network (NCCN), American Urological Association (AUA), European Association of Urology (EAU), and the D’Amico PCa risk stratification schema have similar PCa guidelines, although there is inconsistent classification of cT2c disease among these organizations. According to the original D’Amico risk stratification schema and AUA guidelines, cT2c disease is defined as high risk, whereas the NCCN and EAU guidelines consider cT2c disease as intermediate risk.

Determining whether cT2c disease is intermediate or high risk has important implications for treatment decisions, so it is essential to define the exact risks that cT2c disease portends, Dr. Freedland’s team stated.

Differences in classification, the authors pointed out, may determine the extent of lymph node dissection at the time of RP, the duration of androgen-deprivation therapy given concomitantly with external beam radiotherapy, or eligibility for enrolling in clinical trials.