Originally Posted by: Online Community Member There is also new research that says 2C is not significantly clinically different to T2A or T2B and indeed pathologists in UK are no longer required to state A, B or C anymore and can just record T2 ie confined to prostate. I agree however this is very out of keeping with the old guidelines which have now been disregarded.
Hi IDK2
I have not seen any recent search showing that the old T2c bilateral disease is still not a clinically significant factor in increasing the chance of AS failure. I put links to research papers and old NICE guidelines (which were valid only 4 years ago) which state it was more likely to lead to AS failure and was not suitable for AS.
I would be grateful if you could post a link showing that this is no longer the case.
It seems to me the main reason the T2a, T2b or T2c were all classed as T2 disease was simply because we changed to CPG risk categories instead of the D'Amico it replaced.
Neither of us are medically trained but knowing what we do about this disease, I'm sure we'd both be a lot happier with one lesion in one quarter of the prostate than we would with both lobes containing lesions. Would you rather be told you've got a single lesion in your prostate that's safely contained, than being told your prostate is riddled with cancer but it's safely contained.
In 2020, I was diagnosed with T2c disease and put on AS when NICE guidelines clearly stated at the time T2c disease was high risk and AS was not a suitable treatment option. Yet a year later the goalposts had been moved and it was. I can't see medical research changing and degrading the additional risk of T2c disease in a year, but I can see changing to a different risk stratification doing just that.
Very late edit 🙂
I've now found a link
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375094/#:~:text=Conclusions,confidence%20for%20patients%20and%20physicians.
which shows there is no mortality rate differences between the old T2 sub groups. However, I don't think that negates research showing that that the old T2c disease is more likely to result to AS failure than the old T2a and T2b disease.
The link also explains why the old T2 sub groups were now grouped together as the new T2 group. It also mentions that T2c disease was once deemed high risk purely on its cancer staging alone. Now PSA levels and Gleason score are also combining factors. That's why it risk factor in most cases has been downgraded.
It explains why in 2020, with PSA 5.6, Gleason 6(3+3) and NICE NG 131 stated those with a PSA level greater than 20mg/ml or Gleason 8-10 or a clinical stage equal or greater than T2c, I was deemed high risk and not suitable for AS.
Yet a year later, I was CPG 1 because I had a Gleason score of 6 and a PSA level under 10 ng/ml, and a T stage of 1 or 2. According to them I was now the lowest risk and a prime candidate for AS.
You work that one out.🙂 It's amazing how replacing or with and made such a difference.
In my mind the 'powers that be' are definitely edging towards more AS and less radical treatment. They say they want to avoid men being over treated but I can't help thinking part of it, is to save money. Radical treatment is more costly than AS.
Edited by member 01 Jun 2025 at 10:12
| Reason: Typo