title: Incidence and follow-up of patients with focal prostate carcinoma in 2 screening rounds after an interval of 4 years.
abstract: BACKGROUND
  Focal carcinoma detected by needle biopsy has been a common finding since prostate-specific antigen (PSA)-based screening was introduced. Clinicopathologic features in patients with focal prostate carcinoma who underwent radical prostatectomy (RP) or who were treated with watchful waiting (WW) were analyzed to detect clinical predictors for disease progression during follow-up.
  
  
  METHODS
  Patients were selected from the European Randomized Screening study for Prostate Cancer. Focal carcinoma on sextant biopsy was defined as <or=3.0 mm involvement by tumor in 1 biopsy core lacking Gleason pattern 4 or 5. PSA doubling time was used in the WW group as a marker of disease progression.
  
  
  RESULTS
  The proportion of patients with focal prostate carcinoma increased significantly from 16% in the first screening round to 29% in the second screening round. One hundred eighteen men underwent RP, and 108 men were treated with WW. The median tumor volume was 0.13 mL. PSA level and prostate volume were predictive for tumor volume in a multivariate regression analysis. A PSA density cut-off level of <or=0.1 ng/mL/cm3 predicted organ-confined tumor (<0.5 mL) in 94% of patients. Positive surgical margins were predictive for PSA recurrence. Four patients in the RP group had PSA recurrence at follow-up. PSA doubling times <2 years, <3 years, and <4 years were noted in 4.9%, 14.6%, and 22.0% of patients in the WW group, respectively.
  
  
  CONCLUSIONS
  The median tumor volume was small (0.13 mL). A comparison between PSA recurrence in the RP group and PSA doubling time in the WW group showed a significantly more favorable outcome after RP if a PSA doubling time of <3 years or <4 years was chosen as a marker for disease progression in the WW group. A WW policy with delayed curative intent may be recommended in patients ages 55-75 years with focal carcinoma and PSA density <0.1 ng/mL/cm3.
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands. r.postma@erasmusmc.nl
authors.forename: Rensbe
authors.initials: R
authors.lastname: Postma
authors.forename: Shijn H
authors.initials: SH
authors.lastname: de Vries
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: Mark F
authors.initials: MF
authors.lastname: Wildhagen
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
authors.forename: Theo H
authors.initials: TH
authors.lastname: van der Kwast
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D018450:Disease Progression; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen