Can insignificant prostate cancer be predicted preoperatively in men with stage T1 disease?

This study reviews the pathological findings in nonpalpable prostate cancer detected on transurethral resection (TUR) (stages T1a and T1b) and on needle biopsy (stage T1c) to determine whether insignificant cancers can be predicted preoperatively. The majority of stage T1a cancers are insignificant and all stage T1b cancers are significant. Preoperative pathological parameters cannot identify the minority of T1a cancers that are more significant and the minority of T1b cancers with relatively little residual cancer. Although most nonpalpable tumors diagnosed by screening techniques are usually significant tumors, which would be treated aggressively if they were palpable, 12% to 25% of cancers removed from nonpalpable disease are relatively insignificant. There is conflicting data as to whether a combination of needle biopsy findings and PSA density measurements can aid in the prediction of insignificant cancers. If conservative management is considered, a patient should undergo repeat biopsies (including transition zone biopsies) to detect those more significant cancers that may have been undersampled. In addition, serial serum PSA measurements should be performed to detect whether serum PSA levels increase to a point where these tumors would be reclassified as significant. When planning therapy for T1 patients, the age, comorbidity, and treatment preferences of the patient are key factors that must also be taken into account.