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      Prostate cancer pathologic stage pT2b (2002 TNM staging system): does it exist?

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          Abstract

          OBJECTIVE: In the 1997 TNM staging system, tumors were classified into a single subdivision: T2a, and bilateral tumor involvement (T2b). In the 2002 TNM staging system, tumors are subclassified as T2a (less than one half of one lobe involvement), T2b (more than one half of one lobe involvement), and T2c (bilateral involvement). A recent study questioned the existence of a true pathologic pT2b tumor. The aim of our study is to verify this question. MATERIALS AND METHODS: The study population consisted of 224 men submitted to radical retropubic prostatectomy. The surgical specimens were histologically evaluated by complete embedding and whole-mount processing. Tumor extent was evaluated by a point-count method. The surgical specimens were staged according to the 2002 TNM staging system. RESULTS: Using the 2002 TNM criteria, the surgical specimens were classified as pT2a, 28 (12.50%); pT2b, 0 (0%); pT2c, 138 (61.61%); pT3a, 30 (13.39%); and, pT3b, 28 (12.50%). Using the point-count method for tumor extent evaluation, the minimum and maximum total points obtained in unilateral tumors were 192 and 368 points, respectively; the most extensive unilateral tumor showed 68 positive points (less than half the minimum total point-count). CONCLUSIONS: Using the point-count method for tumor extent, our study questions a real existence for pathologic stage pT2b tumors (unilateral tumors involving greater than one-half of one lobe).

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          Prediction of Prognosis for Prostatic Adenocarcinoma by Combined Histological Grading and Clinical Staging

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            Histologic grading of prostate cancer: a perspective.

            The wide-ranging biologic malignancy of prostate cancer is strongly correlated with its extensive and diverse morphologic appearances. Histologic grading is a valuable research tool that could and should be used more extensively and systematically in patient care. It can improve clinical staging, as outlined by Oesterling et al (J Urol 138: 92-98, 1987), during selection of patients for possible prostatectomy by helping to identify the optimal treatment. Some of the recurrent practical problems with grading (reproducibility, "undergrading" of biopsies, and "lumping" of grades) are discussed and recommendations are made. The newer technologically sophisticated but single-parameter tumor measurements are compared with one important advantage of histologic grading: the ability to encompass the entire low to high range of malignancy. The predictive success of grading suggests that prostate cancers have more or less fixed degrees of malignancy and growth rates (a hypothesis of "biologic determinism") rather than a steady increase in malignancy with time. Most of the observed facts can be interpreted on that basis, including the interrelations of tumor size, grade, and malignancy. The increasing age-adjusted incidence of diagnosed prostate cancer is attributed to new diagnostic tools and increased diagnostic zeal.
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              Intraglandular tumor extent and prognosis in prostatic carcinoma: application of a grid method to prostatectomy specimens.

              The extent of tumor in prostatectomy specimens was determined by a grid method in 117 patients with prostatic adenocarcinoma. A plastic strip or ruler with squares of 3.0 mm was used, and the ratio of squares overlying carcinoma to the total number of squares overlying prostate tissue was calculated. This grid ratio, which represents an estimate of the percentage of the prostate involved by tumor, was a significant prognosticator closely tied to the likelihood of tumor progression and to survival time, as assessed by logistic regression analysis and a proportional hazard model. The grid ratio was better than histologic grade in predicting tumor progression and patient survival; also, the ratio was more objective than histologic grade as judged by interobserver agreement values. Only slight improvement in prognostication was obtained with concurrent use of both extent and grade. The grid ratio method was slightly better in predicting tumor progression and patient survival than a second method of assessing the percentage of prostatic tissue involved by tumor, the pathologist's percentage estimate. These results indicate that it is important to quantitate tumor extent within prostatectomy specimens; such quantitation need not require step-sectioning of the entire prostate and an expensive and time-consuming method such as computerized morphometrics but rather may be performed by a simple estimate of the percentage of the prostate involved by tumor. Reporting of histologic grade and tumor extent in the prostate gland is recommended as both appear to be important in identifying those patients at risk for a poor outcome after prostatectomy for prostatic carcinoma.
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                Author and article information

                Journal
                ibju
                International braz j urol
                Int. braz j urol.
                Sociedade Brasileira de Urologia (Rio de Janeiro, RJ, Brazil )
                1677-5538
                1677-6119
                February 2006
                : 32
                : 1
                : 43-47
                Affiliations
                [01] Campinas SP orgnameUniversity of Campinas orgdiv1School of Medicine orgdiv2Department of Anatomic Pathology (MMQ, MSG, TR, AB) Brazil
                Article
                S1677-55382006000100007 S1677-5538(06)03200107
                10.1590/S1677-55382006000100007
                8d871b0f-f51a-45b2-b847-8303debbc8e1

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
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                SciELO Brazil

                Categories
                Clinical Urology

                carcinoma,prostate-specific antigen,pathology,prostate neoplasms

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