Patterns of Progression in Prostate Cancer

This is the authors' abstract. We don't add key points for this paper.

Tumour volume was related to metastasis, seminal vesicle invasion, capsule invasion, and histological differentiation in a series of 100 unselected prostates with carcinoma removed at necropsy and 38 removed at radical prostatectomy. All these variables were highly inter-related. In both series, metastases were associated only with tumours larger than 4 ml, a volume attained by only 13% of the necropsy tumours. Loss of differentiation was strongly correlated with tumour volume, and only tumours of Gleason grade 4 or 5 had metastasised. It was concluded that the natural history of prostate cancer is highly predictable. The capacity to metastasise probably develops only in tumours which have grown much larger than 1 ml and acquired poorly differentiated areas as a manifestation of the phenomenon of tumour progression. The unusually low proportion of metastatic prostate cancer is readily explained by the large proportion of small-volume tumours in this organ.