PREDICTION OF INSIGNIFICANT PROSTATE CANCER IN MEN WITH STAGE T1C DISEASE

Objective: In this retrospective study, we evaluated the ability of preoperative parameters to predict tumor significance in men with stage T1c disease who underwent radical retropubic prostatectomy.Patients and Methods: A total of 26 consecutive patients who underwent radical retropubic prostatectomy owing to clinically localized disease fulfilled the criteria for insignificant cancer namely PSA density lower or equal to 0.10, presence of Gleason grade <4 (Gleason sum <6), number of cores (<3) involved with cancer, and tumor percentage less than 50% for insignificant prostate cancer. Additionally, we only included the patients with a PSA level of less than 10 ng/ml.Results: According to pathological examination, 6 (23%) of these patients had bilateral (pT2c) disease, 5 (19.2%) had extracapsular disease (pT3a-b), 2 (7.7%) had seminal vesicle (pT3c) involvement and 2 (7.7%) had positive surgical margins. Consequently, at least 50% of these cases were significant cancer.Conclusion: In conclusion, our datademonstrated that the patient and thephysician must be aware of the variability and insufficiency of these preoperative algorithms for predicting insignificant cancers in discussing treatment alternatives.Key Words: Prostate cancer, Stage T1c disease, Insignificant tumor.

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Kramer BS, Brown ML, Prorok PC, Potosky AL, Gohogan JK. Prostate cancer screening: what we know and what we do not know. Ann Intern Med 1993,1 19:914-923.
Wingo PA, Tong T, Boiden S. Cancer statistics. CA Cancer J Clin 1995;45:8-30.
Bostwick DG, Cooner Wli, Denis L, et al. The association of benign prostatic hyperplasia and cancer of the prostate. Cancer 1992;70:291-301.
Stamey TA, Preiha PS, MclTeal JE, et al. Localized prostate cancer: relationship of tumor volume to clinical significance for the treatment of prostate cancer. Cancer 1993;71:933-938.
Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organ confined prostate cancer is increased through prostate specific antigen based screening. JAMA 1993;270:948-954.
Epstein JL Walsh PC, Carmicheal M, Brendler CB. Pathologic and clinic findings to predict tumor extent of nonpalpable (stage Tic) prostate cancer. JAMA 1994;271 .-368-374 .
Ohori M, Wheeler TM, Dunn JK, et al. The pathological features and prognosis of prostate cancer detectable with current diagnostic tests. J Urol 1994; 152:1714-1720.
Gibod LB. Editorial: Significant versus
insignificant prostate cancer-Can we identify the tigers from pussy cats? J Urol 1996; 156: 1069-1070.
Epstein JL Walsh PC, Brendler CB. Radical prostatectomy for impalpable prostate cancer. The John Hopkin s experience with tumours found on transurethral resection (stages Tla and Tib) and on needle biopsy (stage Tic). J Urol 1994,152:1721-1729.
Goto Y, Ohori M, Arakawa A, et al. Distinguishing clinically important from unimportant prostate cancers before treatment. Value of systematic biopsies. J Urol 1996,156:1059-1063.
Humphrey PA, Keetch DW, Smith DS, Shepherland DL, Catalona WJ. Prospective
characterization of pathological features of prostatic carcinomas detected via prostate specific antigen based screening. J Urol 1996;155:816-820.
Oesterling JE, Su man WJ, Zincke H, Bostwick DG. PSA detected (clinical stage Tic or BO) prostate cancer. Urol Clin north Amer 1993;20:687-693.
Weldon VE, Travel PR, Meuwirth H, Cohen R. Failure of focal prostate cancer on biopsy to predict. Focal prostate cancer the importance of prevalence. J Urol 1995;154:1074-1077.
Kojima M, Troncoso P, Babaian RJ. Use of prostate specific antigen and tumor volume in predicting needle biopsy grading error. Urology 1995;45:807-812.
Gardner TA, Lemer ML, Schlegel PH, Waldbaum ED Jr, et al. Microfocal prostate cancer biopsy cancer volume does not predict actual tumor volume. Br J Urol 1998;98:839- 843.
Epstein JL Can insignificant prostate cancer be predicted preoperatively in men stage T1 disease? Semin Urol Oncol 1996; 14:165-1 73.
Lerner SE, Seay TM, Blute ML, Bergstralh EJ, Barrett D, Zincke H. Prostate specific antigen detected prostate cancer (clinical stage Tic): an interim analysis. J Urol 1996; 155:821-826.
Fernandes ET, Sundaram CP, Long R, Sol tan i M, Ercole CJ. Biopsy Gleason score: how does it correlate with the final pathological diagnosis in prostate cancer? Brit J Urol 1997;79:615-617.
Gleason DF. Histologic grading of prostate
cancer: a perspective. Hum Pathol
;23:273-279.
Aihara M, Wheeler TM, Ohori M, et al. Heterogeneity of prostate cancer in radical prostatectomy specimens. Urology 1994;43:60-66.
Cupp MR, Bostwick DG, Myers RP, Oesterling JE. The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectoy specimen on an individual basis. J Urol 1995;153:1543-1548.