Comparison of clinically nonpalpable prostate-specific antigen-detected (cT1c) versus palpable (cT2) prostate cancers in patients undergoing radical retropubic prostatectomy

Objectives. Serum prostate-specific antigen (PSA) testing has led to increa sed detection of clinically localized prostate cancer. We analyzed the clin ical characteristics and outcome of digitally palpable (cT2) and PSA detect ed (cT1c) prostate cancers. Methods. We evaluated 4453 patients with clinically localized prostate canc er who underwent radical retropubic prostatectomy (RRP) between 1987 and 19 95 at the Mayo Clinic. Overall, 1041 (23.4%), 1076 (24.2%), and 2336 (52.5% ) patients had cT1c, cT2a, and cT2b/c disease, respectively. Patients were analyzed with regard to Gleason score, preoperative PSA, pathologic stage, deoxyribonucleic acid (DNA) ploidy, margin status, tumor volume, and adjuva nt treatment. Survival outcomes at 5 and 7 years were estimated using the K aplan-Meier method with respect to the end points of systemic/local clinica l progression and clinical and/or PSA progression (greater than 0.2 mu g/mL ). Multivariate analysis was employed to estimate the relative risk of prog ression associated with each clinical stage when adjusted for the above fac tors. Results, Clinical Tie tumors were more likely to be organ confined (76% ver sus 54%), have a Gleason score less than 7 (75% versus 61%), and be diploid (80% versus 70%) than cT2 b/c tumors (P < 0.001). Clinical T1c disease clo sely resembled cT2b/c disease with respect to preoperative PSA. Considering pathologic stage, DNA ploidy, and tumor volume, cT1c tumors were comparabl e to cT2a lesions. Of the patients with Tie cancers, 96.2% had clinically s ignificant cancer on the basis of pathologic grade and tumor volume. The 5 land 7 year) systemic/local clinical progression-free and PSA progression-f ree survivals for cT1c tumors were 97.7 +/- 0.7% (96.4 +/- 1.1%) and 82.2 /- 1.7% (72.9 +/- 3.8%), respectively. There was a significant survival adv antage at 5 and 7 years regarding both end points for cT1c and cT2a compare d with cT2b/c tumors (P <0.001). Multivariate analysis revealed a continued benefit in PSA and systemic/local clinical progression for cT1c tumors com pared with cT2b/c tumors adjusting for the above factors. Conclusions. Clinical Tie tumors are clinically significant cancers. When c ompared with digitally palpable tumors, progression-free survival rates for cT1c tumors are similar to cT2a lesions, but are significantly better than cT2b/c lesions. This supports continued use of serum PSA to detect potenti ally curable prostate cancer. UROLOGY 54: 105-110, 1999. (C) 1999, Elsevier Science Inc.