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Prostate Cancer Treatment - Stage II Prostate Cancer

Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

Stage II prostate cancer is defined by the following staging systems:

  • American Joint Committee on Cancer's (AJCC) TNM classification system:
    • T1a, N0, M0, G2-4.
    • T1b, N0, M0, any G.
    • T1c, N0, M0, any G.
    • T1 (not further specified), N0, M0, any G.
    • T2, N0, M0, any G.
  • Jewett staging system: stage A2 or B1 or B2.

Previous versions of the AJCC staging system described a tumor's grade as moderately differentiated, poorly differentiated, or undifferentiated, but these terms are no longer used. G2 is the equivalent of moderately differentiated, and G3-4 is the equivalent of poorly differentiated and undifferentiated.

Treatment information for patients whose disease has the following TNM classifications:

  • T1a, N0, M0, G2-4.
  • T1b, N0, M0, any G.
  • T1c, N0, M0, any G.
  • T1 (not further specified), N0, M0, any G.
  • T2, N0, M0, G1-2.

A trial has been reported in which 695 men with newly diagnosed well-differentiated or moderately well-differentiated prostate cancers of clinical stages T1b, T1c, or T2 were randomly assigned to receive radical prostatectomy versus watchful waiting.[1] In contrast to prostate cancer patients in the United States, most of the men in this study had been diagnosed clinically, rather than by screening. At a median follow-up of 6.2 years, prostate cancer-specific mortality was 4.6% in the prostatectomy arm of the study versus 8.9% in the watchful waiting arm (P = .02);[1][Level of evidence: 1iiB] however, overall mortality in the two groups was similar (P = .31).[1][Level of evidence: 1iiA] After 10 years, the difference in overall survival (OS) was approximately 73% versus 68%; absolute difference 5.0%; relative risk of death 0.74 (95% confidence interval [CI], 0.56-0.99). This benefit was restricted to men younger than 65 years at the time of surgery (P = .01 in a planned subset analysis of the effect of age on treatment efficacy).[2] A quality-of-life substudy was conducted in 326 of the men in the randomized study.[3] Men filled out questionnaires at a median of about 4 years after study entry. The principal differences in symptoms between the two groups were in sexual and urinary function. In the surgery and watchful waiting groups, 80% versus 45% of the men answering the questionnaire said they seldom or never had erections sufficient for sexual intercourse. Forty-nine percent of men in the prostatectomy arm had urinary leakage at least once a week, 43% used protective aids regularly, and 14% used diapers or urine bags compared to 21%, 10%, and 1%, respectively, in the watchful waiting arm; however, the men on the watchful waiting arm had more obstructive symptoms (e.g., severe symptoms on the American Urologic Symptom Index of 7% in the watchful waiting arm vs. 10% in the prostatectomy arm and moderate symptoms of 42% vs. 24%).[3][Level of evidence: 1iiC]

1 | 2 | 3 | 4 | 5 | 6

WebMD Public Information from the National Cancer Institute

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER

Last Updated: December 14, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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