Prognostic factors

According to Table 3 the conditional age distributions of the combined T categories 2 until 4 have the same shape and the modus at the age group of 65 until 69. These distributions are shifted slightly towards higher ages with the increasing T category. This simply reflects that it takes time to develop an advanced tumour. However, in those patients diagnosed with T1 category (clinically) the age distribution appears to be totally different. Here 80% of the men are older than 64 (about 60% within the other T categories) and every third man is older than 74.

Lymph node category (N), distant primary metastases (M), Gleason Score, initial PSA value and Gleason Score are positively correlated with the combined T category: the higher the T category, the higher the PSA value, the higher the Gleason Score and the higher the porportion of regional or distant metastases.

A positive lymph node status is mostly diagnosed when the tumour has spread through the prostatic capsule. Nearly 20% of those men with T3 and almost 50% with T4 tumours therefore are diagnosed with lymph node metastasis.

T category

T1

T2

T3

T4

All

%

%

%

%

%

(n=1826

(n=8219

(n=3164

(n=503

(n=13712

13.3%)

59.9%)

23.0%)

3.7%)

100%)

Age (years)

<50

0.5

2.3

1.4

1.8

1.8

50 - 54

1.5

4.5

3.5

3.0

3.8

55 - 59

3.0

11.0

10.2

11.1

9.8

60 - 64

9.7

20.2

18.2

15.1

18.2

65 - 69

20.9

31.4

32.8

26.4

30.1

70 - 74

26.1

20.2

23.1

19.7

21.7

>75

38.3

10.4

10.8

22.9

14.7

Lymph node status

N+

2.5

1.6

18.4

45.1

7.3

N0

40.6

85.2

73.5

33.6

76.2

NX

56.9

13.2

8.1

21.2

16.5

Metastasis status

M0

97.4

98.8

95.4

72.6

96.9

Ml

2.6

1.2

4.6

27.4

3.1

PSA value (ng/ml)

< 4

25.8

13.2

7.8

3.7

13.2

4 - <10

42.0

60.7

41.5

18.9

52.4

10 - <20

17.5

18.3

24.9

15.7

19.7

>20

14.7

7.8

25.7

61.8

14.8

Gleason Score

2 - 4

14.3

1.6

0.2

0.2

2.9

5 - 6

54.8

48.1

12.3

4.2

39.1

7

19.1

40.5

49.4

26.6

39.3

8 - 10

11.8

9.8

38.2

68.9

18.7

Presented numbers are column-wise percentages. T category is a combination of cT and pT.

The disease cohort is limited to 2005-2009 to provide best current estimators.

Table 3. Prognostic factors by T category [4]

Although, only 2.4% of all prostate cancer cases have primary distant metastases, already 25% of the T4 patients are diagnosed with metastases.

About 50% of the men with prostate cancer have a PSA value of 4 to 10 ng/ml at initial diagnosis.

According to Figure 3aa shift from capsule exceeding tumours to capsule limited tumours took place in the 1990s. In the late 1980s about 15% of the diagnosed tumours were staged T4, some 45% T3 and nearly 25% T2. In the 2000s only some 5% of the diagnosed tumours were staged T4, good 20% T3 and about 60% T2. The T1 category was unaffected and oscillated around 12% during the whole time period. It seems that PSA-Screening has considerably lowered the proportion of locally advanced tumours.

Year

Figure 3. Distribution of T category over time (n = 35544) [4]. T category is a combination of cT and pT.

Year

Figure 3. Distribution of T category over time (n = 35544) [4]. T category is a combination of cT and pT.

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