title: Analysis of T1c prostate cancers treated at very low prostate-specific antigen levels.
abstract: BACKGROUND
  The Prostate Cancer Prevention Trial (PCPT) has challenged the validity of recommended prostate-specific antigen (PSA) thresholds for prostate biopsy (> 2.5 ng/ml) given the 17% prostate cancer (pCA) detection rate at PSA of 1.1-2.0. The outcome of patients treated at PSA < or = 2.5 is poorly defined, and advantages associated with such an early diagnosis are uncertain.
  
  
  OBJECTIVE
  Compare the outcome of patients with T1c pCA with pretreatment PSA < or = 2.5 and 2.6-4.0.
  
  
  METHODS
  Since 1998, 351 patients with clinical stage T1c and PSA < or = 4.0 have been treated at our institution; 84 (24%) of those patients had PSA < or = 2.5. Clinical information was obtained from a prospective database. Treatment was radical prostatectomy (RP), brachytherapy, and external-beam radiotherapy (EBRT) in 261 (74%), 67 (19%), and 23 (7%) patients, respectively.
  
  
  METHODS
  Definitive therapy for clinically localized pCA.
  
  
  METHODS
  Progression-free probability and pathologic end points.
  
  
  CONCLUSIONS
  No significant differences between the groups were observed in terms of biopsy (18% vs 22%) or specimen Gleason score 7-8 (44% vs 56%), non-organ-confined cancer (11% vs 13%), indolent cancer (34% vs 24%), or 5-yr progression-free probability (89% vs 93%; p>0.1 for all). More biologically unimportant cancers (defined as pathologically organ-confined and Gleason < or = 6) were identified among patients with PSA < or = 2.5 (55% vs 41%, p=0.050), and indolent cancers were three times more frequent than non-organ-confined cancers among these patients (p=0.003).
  
  
  CONCLUSIONS
  The pathologic features and outcome of patients treated at low PSA levels are favorable and similar for patients with PSA < or = 2.5 versus 2.6-4.0. However, > 50% of the former have potentially biologically unimportant cancer. We failed to identify a therapeutic benefit to the diagnosis of cancers below accepted PSA thresholds for biopsy.
authors.affiliation: Section of Urologic Oncology, Glickman Urological and Kidney Institute, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio 44195-0001, USA. stephea2@ccf.org [corrected]
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.forename: Michael C
authors.initials: MC
authors.lastname: Gong
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*
chemical_list: D017430:Prostate-Specific Antigen