Clinically unsuspected and undetected (clinical stage to) prostate cancer diagnosed on random needle biopsy

Objectives. To describe the findings in 4 patients who underwent radical pr ostatectomy for clinically undetected and unsuspected prostate cancer detec ted on random needle biopsy. Methods. We reviewed the Mayo Clinic Radical Prostatectomy Prostate Cancer Database of 5793 prostatectomies from 1987 to 1997, and identified 4 patien ts who had prostate cancer detected on random needle biopsy of the prostate with serum prostate-specific antigen (PSA) less than 4 ng/mL and normal di gital rectal examination. Each had requested biopsy despite the absence of clinical suspicion of cancer; 3 had normal transrectal ultrasound, and the fourth had a benign hypoechoic lesion contralateral to the cancer. Results. Mean patient age at diagnosis was 65.5 years (range 61 to 67). Mea n PSA was 2.4 ng/mL (range 2 to 2.9). Mean tumor volume was 3 cc (range 0.0 4 to 11.2). Mean Gleason grade at prostatectomy was 5.75 (range 5 to 7). Pr ostate cancer was Stage T2a in 1 patient (25%), T2c in 2 (50%), and T3a (25 %) in 1. Three tumors were DNA diploid, and one was aneuploid. All patients were alive without evidence of cancer at a mean follow-up of 43 months (ra nge 25 to 53) with undetectable serum PSA concentration. Conclusions. Our findings indicate that clinically unsuspected and undetect ed (clinical Stage TO) prostate cancer may be clinically significant. Patie nt insistence on biopsy reflects increasing concern among the public about prostate cancer. Current clinical thresholds for biopsy detection will fail for some patients with clinically significant prostate cancer. (C) 1999, E lsevier Science Inc. All rights reserved.