PROSTATE-SPECIFIC ANTIGEN-DETECTED PROSTATE-CANCER (STAGE T1C) - AN ANALYSIS OF WHOLE-MOUNT PROSTATECTOMY SPECIMENS

BACKGROUND. Clinical and pathological staging of prostate cancer has b een, and remains, problematic. Since prostate-specific antigen (PSA)-d etected tumors are often discerned during ''screening,'' what are thei r significance? METHODS. We analyzed 67 consecutive patients with stag e Tie prostate cancer undergoing radical prostatectomy at our institut ion from August 1, 1991-September 12, 1995, and who had whole-mount sp ecimen processing. Diagnosis was determined in all cases by transrecta l ultrasound-guided biopsy. RESULTS. The mean age of our patients was 63 years, and the mean PSA at time of diagnosis was 8.6 ng/ml (median, 7.2 ng/ml). There was organ-confined cancer in 31/67 (46%) patients; 17/67 (25%) had periprostatic fat infiltration, and of these 5 (7%) ha d seminal vesicle involvement. Thirty-one of 67 (46%) had positive sur gical margins. Twenty-two (33%) had a Gleason sum of greater than or e qual to 7 in the final pathological specimen. Insignificant tumors (do minant tumor volume <0.20 cc) were found in only 4 cases. Smaller tumo rs were more likely to be found when the PSA was <10 ng/ml. Multifocal disease was found in 64/67 (96%) prostate specimens. CONCLUSIONS. Thi s study adds impetus to the growing realization that nonpalpable prost ate cancer, detected because of elevated PSA, is rarely insignificant. Our findings add further emphasis to the fact that patients diagnosed by PSA elevation have, for the most part, significant cancer that sho uld be treated aggressively. (C) 1997 Wiley-Liss, Inc.