HISTOLOGICAL CHARACTERISTICS OF RADICAL PROSTATECTOMY SPECIMENS IN MEN WITH A SERUM PROSTATE-SPECIFIC ANTIGEN OF 4 NG ML OR LESS/

Purpose: Of most reported radical prostatectomy series 20% consist of men with a serum prostate specific antigen (PSA) of 4.0 ng./ml. or les s. Since our series is not only prospective but all prostates are reco nstructed at 3 mm. intervals, we determined the clinical and histologi cal findings in this important subset of men undergoing radical prosta tectomy. Materials and Methods: Of 911 consecutive men undergoing radi cal prostatectomy 187 (21%) had a preoperative serum PSA of 4.0 ng./ml . or less (values equivalent to those of the Hybritech Tandem-R assay) . Results: Mean tumor volume was 2.3 cc. Of the 187 cancers 156 (83%) were in the peripheral zone and 31 (17%) in the transition zone, while 137 (73%) were organ-confined and 50 (27%) showed capsular penetratio n. No patient had positive pelvic lymph nodes, only 5 had seminal vesi cle invasion and positive surgical margins were present in 14%. Cancer volumes less than 0.5 cc were noted in 9% of the patients and were pr obably insignificant. At an average followup of 37 months, only 16 men (9%) had a detectable serum PSA. These 16 patients had a larger tumor volume (3.7 cc versus 2.2 cc, p < 0.05), and a greater percent of Gle ason grade 4 and/or 5 disease than the 171 with undetectable PSA. Conc lusions: Men with prostate cancer and a serum PSA of 4.0 ng./ml. or le ss are excellent candidates for radical prostatectomy if the 9% with c linically insignificant tumors can be avoided. Since 70% of all men ha d a suspicious prostate on digital rectal examination, this evaluation is important for men with a serum PSA of 4.0 ng./ml. or less.