Six-year follow-up of untreated T1 carcinoma of prostate.
BACKGROUND
The management of T1 carcinoma of prostate remains controversial and the critical role of histopathology is often underestimated.


METHODS
A retrospective review was conducted on 27 cases of T1 prostate carcinoma diagnosed between 1980 and 1992, all of which were managed on a surveillance programme. Pathological material of 24 cases was available for re-examination by a single histopathologist without prior knowledge of the originally assigned grade. Gleason's scoring system was used in the current review.


RESULTS
Twenty-two (81.5%) were T1a and 5 (18.5%) T1b. Mean duration of follow-up was 77.3 months (1.0 to 159.0) and median age was 72.0 years (61.0 to 84.0). Twenty-five (92.6%) were originally graded as well differentiated, 1 (3.7%) was moderately differentiated and 1 (3.7%) was poorly differentiated. Three of the well-differentiated tumours were upstaged because of tumour volume. On review, differences in grading were noted in 13 cases (54.2%) and 11 (45.8%) were, as a consequence, upstaged. Progression was recorded in 5 cases (18.5%). Mean disease-free interval was 47.6 months (7.0 to 75.0) and mean serum PSA at progression was 34.2 ug/l (2.3 to 62.5). Four responded to delayed therapy. Mortality was recorded in 13 cases (48.1%) but cancer-specific mortality was only 7.7% (1/13). Mean age at death was 78.1 years.


CONCLUSIONS
The importance of accurate grading and staging cannot be overemphasized given its pivotal role in subsequent management. The impact of age is also apparent and surveillance appears a reasonable option for those with limited life expectancy after diagnosis.
Toh
K L
KL
Department of Urology, Singapore General Hospital, Singapore.
Tan
P H
PH
Cheng
C W
CW
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D000368:Aged; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate
D017430:Prostate-Specific Antigen