Classifying stage 2c prostate tumors as intermediate or high-risk

The authors aimed to determine whether patients with T2c prostate tumors had an intermediate or high-risk disease. 

Prostate cancer can be classified as low, intermediate or high-risk. This is based on the risk factors present. Risk factors include high prostate specific antigen levels (PSA – protein elevated in the blood when prostate cancer is present) and high Gleason scores (scoring system that compares the differences between cancer and normal cells). It also includes tumor staging which identifies the size and area of the tumor.

Risk factors for intermediate-risk cancer include a PSA level of 10-20ng/ml, Gleason score of 7 and a stage 2b tumor (cancer is in one half of the prostate gland). Risk factors for high-risk cancer include a PSA level of more than 20ng/ml or a Gleason score of 8-10. It also includes a stage 2c, 3 or 4 tumor (cancer is in full prostate gland, has spread outside the prostate or has invaded  tissues and organs). It is not yet clear whether stage 2c cancer is intermediate or high-risk.

The aim of this study was to determine the risk of stage 2c tumors.

2,759 patients were used in group 1 with a follow-up time of 66 months. 12,900 patients were used in group 2 with a follow-up of 48 months. 

In group 1, 4% of patients had stage 2 tumors with no high-risk factors (PSA over 20, Gleason score 8-10). 37% of these patients experienced biochemical recurrence (increase in PSA levels indicating prostate cancer has returned). In group 2, 2% of patients had stage 2 tumors with no high-risk factors. 30% of these patients experienced biochemical recurrence.

Patients with stage 2c tumors and no high-risk factors had an almost identical risk of experiencing biochemical recurrence to intermediate-risk patients. They had significantly lower biochemical recurrence rates compared to high-risk patients. 

Patients with stage 2c tumors and no high-risk factors had significantly similar disease outcomes (risk of biochemical recurrence, death from prostate cancer) to intermediate-risk patients. They had significantly better disease outcomes compared to high-risk patients. 

The authors concluded that patients with stage 2c tumors with no high-risk factors had similar disease outcomes to intermediate-risk patients and significantly better outcomes than high-risk patients. 

Please consult your doctor on the most beneficial treatment for intermediate or high-risk prostate cancer.