Contemporary validation of cT1a vs. cT1b substaging of incidental prostate cancer

Lukas Scheipner ^1,2, Andrea Baudo ^3,4, Letizia Maria Ippolita Jannello ^3,5,6

¹Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. l.scheipner@medunigraz.at.
²Department of Urology, Medical University of Graz, Auenbruggerpl. 1, 8036, Graz, Österreich Graz, Austria. l.scheipner@medunigraz.at.
³Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁴Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
⁵Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
⁶Università Degli Studi Di Milano, Milan, Italy.
⁷Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.
⁸Department of Urology, Comprehensive Cancer Center, Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁹Medical University of Vienna, Vienna, Austria.
¹⁰Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹¹Department of Urology, University of Texas Southwestern, Dallas, TX,, USA.
¹²Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹³Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy.
¹⁴Department of Urology, Medical University of Graz, Auenbruggerpl. 1, 8036, Graz, Österreich Graz, Austria.

⁰Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. l.scheipner@medunigraz.at.

World Journal of Urology +

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April 28, 2024

View abstract on PubMed

Summary

The cT1a vs. cT1b substaging in incidental prostate cancer (PCa) effectively predicts cancer-specific survival (CSS) in patients not receiving active treatment, particularly those with higher Gleason scores (GS). The distinction is less significant for actively treated patients.

Area Of Science

Urology
Oncology
Cancer Research

Background

The cT1a vs. cT1b substaging for incidental prostate cancer (PCa) was established in 1992 but has not been rigorously validated.
Contemporary data are needed to assess the clinical utility of this substaging in predicting cancer-specific survival (CSS).

Purpose Of The Study

To evaluate the discriminative ability of cT1a vs. cT1b substaging on CSS in a contemporary cohort of incidental PCa patients.
To determine if this substaging impacts survival outcomes based on treatment approach and Gleason score (GS).

Main Methods

Utilized the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to identify incidental PCa patients (cT1a/cT1b).
Employed Kaplan-Meier estimates and Cox regression models to analyze CSS at five years.
Conducted subgroup analyses based on active treatment vs. no local treatment (NLT) and GS (6, 7, ≥8).

Main Results

Identified 5,155 incidental PCa patients (3,035 cT1a, 2,120 cT1b). Overall five-year CSS was 95%.
cT1b patients had significantly lower CSS (90%) compared to cT1a patients (98%) (p<0.001).
In multivariable analysis for NLT patients, cT1b independently predicted 2.8-fold higher cancer-specific mortality (CSM) (HR 2.5, p<0.001), particularly in GS 7 and GS ≥8 subgroups.

Conclusions

The cT1a vs. cT1b substaging effectively discriminates CSS in incidental PCa patients with GS 7 and GS ≥8 who undergo NLT.
No statistically significant difference in CSS was observed between cT1a and cT1b in actively treated patients.
The clinical relevance of cT1a/cT1b substaging is primarily for GS ≥8 patients managed with a non-active treatment approach.

Keywords:

CSS Incidental prostate cancer Prognosis Staging Validation