Predictive factors for progression in patients with clinical stage T1a prostate cancer in the PSA era.
OBJECTIVE
In the literature, most data regarding the outcome of patients with clinical stage T1a prostate cancer were established before the prostate-specific antigen (PSA) era. The aim of our study was to determine the predictive factors of progression in patients with T1a prostate cancer diagnosed in the PSA era.


METHODS
Consecutive patients (n=144) with newly diagnosed T1a prostate cancer (tumor involving < or =5% of the resected prostatic tissue) were included. None of them was treated before evidence of tumor progression confirmed by prostate needle biopsies. The associations between tumor characteristics and time to cancer progression were assessed using Cox regression analysis.


RESULTS
With a mean follow-up of 5.1 yr, 30 patients (21%) experienced cancer progression. Five adverse parameters were significantly associated with cancer progression: preoperative PSA> or =10 ng/ml, postoperative PSA> or =2 ng/ml, prostate weight > or =60 g, weight of resected tissue > or =40 g, and Gleason score> or =6. The 5-yr progression rate was 12% if fewer than two of these parameters were present, whereas it was 47% if two or more parameters were present (p<0.001).


CONCLUSIONS
In the PSA era the risk of progression associated with T1a prostate cancer can be predicted using five criteria, and two groups of patients can be defined. The patients at low risk of progression may be good candidates for surveillance. In those with a high risk of progression, a more aggressive treatment should be discussed.
Descazeaud
Aurelien
A
Department of Urology, Cochin Hospital, Paris, France. aureliendescazeaud@hotmail.com
Peyromaure
Michael
M
Salin
Ambroise
A
Amsellem-Ouazana
Delphine
D
Flam
Thierry
T
Viellefond
Annick
A
Debré
Bernard
B
Zerbib
Marc
M
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D012372:ROC Curve; D012307:Risk Factors
D017430:Prostate-Specific Antigen