Background: Whether patients who are diagnosed on the basis of a single microscopic focus of prostate carcinoma with a Gleason score </= 7 (micro PC) have potentially life-threatening disease if they are not treated is unknown.
Methods: Pathologic findings and prostate specific antigen (PSA) outcome after radical prostatectomy (RP) for men who were diagnosed with micro PC were determined. Of 917 patients who were managed with RP during 1989-1999 at the Brigham and Women's Hospital, 66 patients (7%) were diagnosed on the basis of micro PC. Pathologic stage, tumor grade, tumor volume, margin status, and PSA outcome were investigated and are reported. Estimates of PSA outcome were calculated using the actuarial method of Kaplan and Meier. Pairwise comparisons were made using the log rank test.
Results: The finding of micro PC at biopsy was associated with macroscopic disease (involving at least half of a single lobe) in 92% of the patients in this series. Although these men had favorable pathologic findings (94% had organ confined disease, 89% had negative tumor margins, and 79% had a prostatectomy Gleason score </= 6), approximately 10% of the patients failed biochemically within 5 years after RP.
Conclusions: The finding of micro PC at biopsy should not be used as a surrogate for clinically insignificant disease.
Copyright 2000 American Cancer Society.