Staging of prostate cancer

Abstract

Prostatic carcinoma (PCa) is a significant cause of cancer morbidity and mortality worldwide. Accurate staging is critical for prognosis assessment and treatment planning for PCa. Despite the large volume of clinical activity and research, the challenge to define the most appropriate and clinically relevant staging system remains. The pathologically complex and uncertain clinical course of prostate cancer further complicates the design of staging classification and a substaging system suitable for individualized care. This review will focus on recent progress and controversial issues related to prostate cancer staging. The 2010 revision of the American Joint Committee on Cancer/Union Internationale Contre le Cancer (AJCC/UICC) tumour, node and metastasis (TNM) system is the most widely used staging system at this time. Despite general acceptance of the system as a whole, there is controversy and uncertainty about its application, particularly for T2 subclassification. The three-tiered T2 classification system for organ-confined prostate cancer is superfluous, considering the biology and anatomy of PCa. A tumour size-based substaging system may be considered in the future TNM subclassification of pT2 cancer. Lymph node status is one of the most important prognostic factors for prostate cancer. Nevertheless, clinical outcomes in patients with positive lymph nodes are variable. Identification of patients at the greatest risk of systemic progression helps in the selection of appropriate therapy. The data suggest that the inherent aggressiveness of metastatic prostate cancer is closely linked to the tumour volume of lymph node metastasis. We recommend that a future TNM staging system should consider subclassification of node-positive cancer on the basis of nodal cancer volume, using the diameter of the largest nodal metastasis and/or the number of positive nodes.

Alternatively activated macrophages are associated with metastasis and poor prognosis in prostate adenocarcinoma

“…All the patients received androgen deprivation therapy using a hormone-releasing hormone agonist analogue. Tumors were confirmed histopathologically and were staged according to the AJCC/UICC TNM System (22). The histological types were determined by two independent clinical pathologists in a double-blinded manner: all the samples were PCa.…”

Crude extract of Euphorbia formosana inhibits the migration and invasion of DU145 human prostate cancer cells: The role of matrix metalloproteinase-2/9 inhibition via the MAPK signaling pathway

“…In the Western world, prostate cancer is the second leading cause of cancer-related mortality in males due to its high prevalence and metastatic rate (4)(5). In Taiwan, prostate cancer is the seventh leading cause of cancer-related mortality (6).…”

Anatomic, morphologic and genetic heterogeneity of prostate cancer: implications for clinical practice

“…There was an excellent correlation between tumor size (maximum tumor diameter) and prostate cancer volume [13]. We propose that maximum tumor diameter may be used for pT2 substaging [14]. The majority of cases with a maximum tumor diameter of ≤0.5 cm have a tumor volume of ≤0.5 cm 3 .…”

“…Therefore, it appears to be reasonable to use 0.5 and 1.6 cm as cutoffs for substaging of pT2 prostate cancer. We have proposed a new subclassification of pT2 prostate cancers based on tumor size [14]. In this proposal, pT2a tumors are organ-confined cancers with a largest tumor dimension of ≤0.5 cm; pT2b tumors are organ-confined cancers with a largest tumor dimension of >0.5 cm, but ≤1.6 cm; and pT2c tumors are organ-confined cancers with a largest tumor dimension of >1.6 cm [14].…”