Small high grade adenocarcinoma of the prostate in radical prostatectomy specimens performed for nonpalpable disease: Pathogenetic and clinical implications

Research output: Contribution to journalArticle

Abstract

It has been suggested that poorly differentiated areas in prostatic carcinoma evolve from more well differentiated cancer with time and increasing tumor volume. However, the association of high grade tumor with increasing tumor volume may merely reflect a growth advantage of the high grade tumor, whereby most high grade tumors would be large by the time they were clinically detected. Prior reports analyzing the relationship of tumor volume and grade suffer from studying fairly advanced tumors in which the relationship of tumor volume and grade at inception of prostate cancer could not be addressed. We evaluated 720 individual tumor foci in 153 radical prostatectomy specimens removed for early prostate cancer detected by screening techniques. Although tumor volume was related to grade, the correlation was weak (r = 0.254). Of 13 peripherally located high grade tumors (Gleason score 8 to 10) 6 (46%) were less than 1 cc. Of 106 peripheral tumors with some Gleason pattern 4 or 5 component 48 (45%) were less than 1 cc. These small high grade tumors were frequently associated with high grade prostatic intraepithelial neoplasia. Small high grade cancers were uncommon within the transition zone, where there exists a greater tendency for large low grade cancers to arise. In this radical prostatectomy series of nonpalpable prostate cancer 9% of the prostates contained tumor foci that were predominantly Gleason pattern 4 or 5 and that measured 1 cc or less. Based on these findings, if some patients with low to intermediate grade cancer are to be followed expectantly, they should undergo widespread sampling of the prostate to enhance the detection of multifocal small high grade disease. The finding of a large proportion of low volume, high grade carcinoma reveals that prostate cancer has the potential to be high grade early in its course and need not arise from low grade carcinoma that has evolved with time and volume.

Original languageEnglish (US)
Pages (from-to)1587-1592
Number of pages6
JournalJournal of Urology
Volume151
Issue number6
StatePublished - 1994

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Prostatectomy
Prostate
Adenocarcinoma
Neoplasms
Tumor Burden
Prostatic Neoplasms
Carcinoma
Prostatic Intraepithelial Neoplasia
Neoplasm Grading
Early Detection of Cancer

Keywords

  • adenocarcinoma
  • neoplasms, glandular epithelial
  • prostatectomy
  • prostatic neoplasms
  • tumor staging

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Small high grade adenocarcinoma of the prostate in radical prostatectomy specimens performed for nonpalpable disease: Pathogenetic and clinical implications",
abstract = "It has been suggested that poorly differentiated areas in prostatic carcinoma evolve from more well differentiated cancer with time and increasing tumor volume. However, the association of high grade tumor with increasing tumor volume may merely reflect a growth advantage of the high grade tumor, whereby most high grade tumors would be large by the time they were clinically detected. Prior reports analyzing the relationship of tumor volume and grade suffer from studying fairly advanced tumors in which the relationship of tumor volume and grade at inception of prostate cancer could not be addressed. We evaluated 720 individual tumor foci in 153 radical prostatectomy specimens removed for early prostate cancer detected by screening techniques. Although tumor volume was related to grade, the correlation was weak (r = 0.254). Of 13 peripherally located high grade tumors (Gleason score 8 to 10) 6 (46{\%}) were less than 1 cc. Of 106 peripheral tumors with some Gleason pattern 4 or 5 component 48 (45{\%}) were less than 1 cc. These small high grade tumors were frequently associated with high grade prostatic intraepithelial neoplasia. Small high grade cancers were uncommon within the transition zone, where there exists a greater tendency for large low grade cancers to arise. In this radical prostatectomy series of nonpalpable prostate cancer 9{\%} of the prostates contained tumor foci that were predominantly Gleason pattern 4 or 5 and that measured 1 cc or less. Based on these findings, if some patients with low to intermediate grade cancer are to be followed expectantly, they should undergo widespread sampling of the prostate to enhance the detection of multifocal small high grade disease. The finding of a large proportion of low volume, high grade carcinoma reveals that prostate cancer has the potential to be high grade early in its course and need not arise from low grade carcinoma that has evolved with time and volume.",
keywords = "adenocarcinoma, neoplasms, glandular epithelial, prostatectomy, prostatic neoplasms, tumor staging",
author = "Epstein, {Jonathan Ira} and Carmichael, {M. J.} and Partin, {Alan Wayne} and Patrick Walsh",
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language = "English (US)",
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T1 - Small high grade adenocarcinoma of the prostate in radical prostatectomy specimens performed for nonpalpable disease

T2 - Pathogenetic and clinical implications

AU - Epstein, Jonathan Ira

AU - Carmichael, M. J.

AU - Partin, Alan Wayne

AU - Walsh, Patrick

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N2 - It has been suggested that poorly differentiated areas in prostatic carcinoma evolve from more well differentiated cancer with time and increasing tumor volume. However, the association of high grade tumor with increasing tumor volume may merely reflect a growth advantage of the high grade tumor, whereby most high grade tumors would be large by the time they were clinically detected. Prior reports analyzing the relationship of tumor volume and grade suffer from studying fairly advanced tumors in which the relationship of tumor volume and grade at inception of prostate cancer could not be addressed. We evaluated 720 individual tumor foci in 153 radical prostatectomy specimens removed for early prostate cancer detected by screening techniques. Although tumor volume was related to grade, the correlation was weak (r = 0.254). Of 13 peripherally located high grade tumors (Gleason score 8 to 10) 6 (46%) were less than 1 cc. Of 106 peripheral tumors with some Gleason pattern 4 or 5 component 48 (45%) were less than 1 cc. These small high grade tumors were frequently associated with high grade prostatic intraepithelial neoplasia. Small high grade cancers were uncommon within the transition zone, where there exists a greater tendency for large low grade cancers to arise. In this radical prostatectomy series of nonpalpable prostate cancer 9% of the prostates contained tumor foci that were predominantly Gleason pattern 4 or 5 and that measured 1 cc or less. Based on these findings, if some patients with low to intermediate grade cancer are to be followed expectantly, they should undergo widespread sampling of the prostate to enhance the detection of multifocal small high grade disease. The finding of a large proportion of low volume, high grade carcinoma reveals that prostate cancer has the potential to be high grade early in its course and need not arise from low grade carcinoma that has evolved with time and volume.

AB - It has been suggested that poorly differentiated areas in prostatic carcinoma evolve from more well differentiated cancer with time and increasing tumor volume. However, the association of high grade tumor with increasing tumor volume may merely reflect a growth advantage of the high grade tumor, whereby most high grade tumors would be large by the time they were clinically detected. Prior reports analyzing the relationship of tumor volume and grade suffer from studying fairly advanced tumors in which the relationship of tumor volume and grade at inception of prostate cancer could not be addressed. We evaluated 720 individual tumor foci in 153 radical prostatectomy specimens removed for early prostate cancer detected by screening techniques. Although tumor volume was related to grade, the correlation was weak (r = 0.254). Of 13 peripherally located high grade tumors (Gleason score 8 to 10) 6 (46%) were less than 1 cc. Of 106 peripheral tumors with some Gleason pattern 4 or 5 component 48 (45%) were less than 1 cc. These small high grade tumors were frequently associated with high grade prostatic intraepithelial neoplasia. Small high grade cancers were uncommon within the transition zone, where there exists a greater tendency for large low grade cancers to arise. In this radical prostatectomy series of nonpalpable prostate cancer 9% of the prostates contained tumor foci that were predominantly Gleason pattern 4 or 5 and that measured 1 cc or less. Based on these findings, if some patients with low to intermediate grade cancer are to be followed expectantly, they should undergo widespread sampling of the prostate to enhance the detection of multifocal small high grade disease. The finding of a large proportion of low volume, high grade carcinoma reveals that prostate cancer has the potential to be high grade early in its course and need not arise from low grade carcinoma that has evolved with time and volume.

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