MANAGEMENT OF STAGE T1C PROSTATE-CANCER

Serum prostate specific antigen (PSA) can identify prostate cancers no t palpable by digital rectal examination. Prostate cancer is detected more often by PSA than by digital rectal exam. In the TNM staging syst em, these ''PSA-detected'' cancers are classified as Stage T1c. In gen eral, these Stage T1c cancers are pathologically found to be more exte nsive than Stage Tla cancers, which are often followed without immedia te treatment, and less than or similarly extensive to Stage T2 cancers , which are often managed with definitive treatment. Eleven to thirty percent have tumor volumes less than 0.5 cm,(3) which rarely progress clinically. Unfortunately, there is no certain way to determine these ''insignificant'' tumors, although serum PSA level, PSA density, and n eedle biopsy pathologic findings are accurate predictors of tumor exte nt. In many cases, serial PSA measurements might better define which p atients can be followed and which need definitive treatment.