Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer

Objectives. —We examined preoperative clinical and pathologic parameters in men with clinical stage T1c disease who underwent radical prostatectomy and correlated these findings with the pathologic extent of disease in the surgical specimen in an attempt to identify a subset of patients with potentially biologically insignificant tumor who might be followed up without immediate treatment. Design and Patients. —A case series of 157 consecutive men who underwent radical prostatectomy for clinical stage T1c disease compared with 64 similarly treated clinical stage T1a cancers (incidental minimal cancers found on transurethral resection of prostate) and 439 clinical stage T2 (palpable) cancers. Main Outcome Measures. —Pathologic stage, grade, and margins; tumor volume; and tumor location. Results. —Sixteen percent of tumors were insignificant (3and confined to the prostate, with a Gleason score 3and confined to the prostate, with a Gleason score 0.5 cm3or capsular penetration, with a Gleason score Conclusions. —Eighty-four percent of nonpalpable prostate cancers diagnosed by screening techniques are significant tumors and warrant definitive therapy. However, 16% are insignificant. Serum PSA level, PSA density, and needle biopsy pathologic findings are accurate predictors of tumor extent. It may be reasonable to follow up some patients whose tumors are most likely insignificant with serial PSA measurements and repeated biopsies. (JAMA. 1994;271:368-374)