Significance of small foci of Gleason score 7 or greater prostate cancer on needle biopsy

Objectives. With increased screening for prostate cancer, we have noted a g reater number of patients with small foci of Gleason score 7 or greater pro state cancer on needle biopsy. The significance of these findings is unknow n. Methods. We studied 57 men with small foci of Gleason score 7 or greater on needle biopsy. Tumor length was less than 1.5 mm in all but 2 cases. In th ose 2 cases, there were two minute (less than 0.5 mm) foci of cancer separa ted by 1.8 mm. The length of cancer ranged from 0.2 to 1.8 mm (mean 0.63 mm ). In all cases, only one core was involved. Results, Thirty-three men underwent radical prostatectomy (RP), 14 received radiation, 8 underwent surveillance, and 2 received hormonal therapy. Men who underwent RP were younger (62 years) than those who had radiotherapy (6 9.1 years), who were younger than those who underwent surveillance (74.5 ye ars). The mean prostate-specific antigen (PSA) for men undergoing RP was 8. 0 ng/mL (range 1.4 to 22). Preoperative serum PSA values did not predict or gan-confined status. Needle biopsy grades were as follows: 3 + 4 = 7 (n = 3 0); 4 + 3 = 7 (n = 17), 4 + 4 = 8 (n = 7); 5 + 4 = 9 (n = 1); and 5 + 5 = 1 0 (n = 2), We were able to review slides in 27 of the RP specimens, of whic h 24 were well sampled. Of these 24 cases, 35% had positive margins and 33% were not organ confined; the median tumor volume was 0.5 cc (mean 1.04), N o difference in RP tumor volume was found between tumors with needle biopsy Gleason primary grade 3 and those with 4 or greater. The percentage of Gle ason pattern 4 on needle biopsy weakly correlated with the percentage of Gl eason pattern 4 in the RP specimen (P = 0.04). However, the percentage of G leason pattern 4 only in the RP specimen, but not in the biopsy, correlated with whether the tumor was organ confined. Conclusions. The likelihood of having organ-confined disease with small foc i of Gleason score 7 or greater on needle biopsy appears to be equivalent t o that calculated from the Partin Tables for greater amounts of Gleason sco re 6 cancer on needle biopsy. In men who are considering RP, small foci of Gleason score 7 or greater adenocarcinoma on needle biopsy should not neces sarily be considered an adverse finding. (C) 1999, Elsevier Science Inc.