Pathologic findings and prostate specific antigen outcome after radical prostatectomy for patients diagnosed on the basis of a single microscopic focus of prostate carcinoma with a gleason score </= 7.
BACKGROUND
Whether patients who are diagnosed on the basis of a single microscopic focus of prostate carcinoma with a Gleason score </= 7 (micro PC) have potentially life-threatening disease if they are not treated is unknown.


METHODS
Pathologic findings and prostate specific antigen (PSA) outcome after radical prostatectomy (RP) for men who were diagnosed with micro PC were determined. Of 917 patients who were managed with RP during 1989-1999 at the Brigham and Women's Hospital, 66 patients (7%) were diagnosed on the basis of micro PC. Pathologic stage, tumor grade, tumor volume, margin status, and PSA outcome were investigated and are reported. Estimates of PSA outcome were calculated using the actuarial method of Kaplan and Meier. Pairwise comparisons were made using the log rank test.


RESULTS
The finding of micro PC at biopsy was associated with macroscopic disease (involving at least half of a single lobe) in 92% of the patients in this series. Although these men had favorable pathologic findings (94% had organ confined disease, 89% had negative tumor margins, and 79% had a prostatectomy Gleason score </= 6), approximately 10% of the patients failed biochemically within 5 years after RP.


CONCLUSIONS
The finding of micro PC at biopsy should not be used as a surrogate for clinically insignificant disease.
D'Amico
A V
AV
Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA. adamico@jcrt.harvard.edu
Wu
Y
Y
Chen
M H
MH
Nash
M
M
Renshaw
A A
AA
Richie
J P
JP
D001706:Biopsy / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015203:Reproducibility of Results; D015996:Survival Rate; D013997:Time Factors
D017430:Prostate-Specific Antigen