Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens

Some investigators consider small-volume prostate cancer (0.5 ml or less) without Gleason pattern 4/5 elements as clinically insignificant. The objective of this study was to characterize the anatomic distribution and pathologic features of small tumors (aggregate volume of 0.5 ml or less) in whole-mount prostatectomy specimens. Between 1999 and 2003, 371 consecutive patients underwent radical prostatectomy at the Indiana University Hospitals for localized prostate cancer. Patients who received hormonal or radiation therapy prior to the surgery were excluded from the study. A total of 62 specimens with total tumor volume of 0.5 ml or less were identified and included in this study. All specimens were embedded and whole-mounted. Tumor volume was measured using the grid method. The mean age at the time of surgery was 59 years (median, 61 years; range, 37–72 years). The mean preoperative prostate-specific antigen (PSA) was 6.5 ng/ml (range: 0.3–18 ng/ml). The mean prostate weight was 53 g (range: 16–132 g). The mean tumor volume was 0.29 ml (median, 0.35 ml; range, 0.02–0.48 ml). Tumor multifocality and bilaterality were present in 69 and 37% of cases, respectively. Three (5%) had positive surgical margins. The largest tumor was located in the peripheral zone, transitional zone, and central zone in 79, 16, and 5% of cases, respectively. The largest tumor was located in the anterior prostate in 10 cases (16%) and in the posterior prostate in 52 cases (84%). The distribution of Gleason scores was 5 (12 cases, 19 %), 6 (40 cases, 65 %), and 7 (10 cases, 16 %). One case had a primary Gleason pattern 4. None had extraprostatic extension, seminal vesicle invasion, or lymph node metastasis. Small-volume prostate cancers are often multifocal and bilateral, with predilection for the peripheral zone. Of these small-volume cases, 16% had Gleason pattern 4 and might, therefore, be clinically significant.

[1]  D. Gleason,et al.  Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. , 1974, The Journal of urology.

[2]  T. Stamey,et al.  PATTERNS OF PROGRESSION IN PROSTATE CANCER , 1986, The Lancet.

[3]  T. Stamey,et al.  Morphometric and clinical studies on 68 consecutive radical prostatectomies. , 1988, The Journal of urology.

[4]  T. Stamey,et al.  Pathogenesis and biological significance of seminal vesicle invasion in prostatic adenocarcinoma. , 1990, The Journal of urology.

[5]  P. Humphrey,et al.  Intraglandular tumor extent and prognosis in prostatic carcinoma: application of a grid method to prostatectomy specimens. , 1990, Human pathology.

[6]  A. D'Amico,et al.  Linear regressive analysis using prostate‐specific antigen doubling time for predicting tumor biology and clinical outcome in prostate cancer , 1993, Cancer.

[7]  D. Bostwick,et al.  Staging of early prostate cancer: a proposed tumor volume-based prognostic index. , 1993, Urology.

[8]  T. Stamey,et al.  Clinical observations on the doubling time of prostate cancer. , 1993, European urology.

[9]  A S Whittemore,et al.  Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer , 1993, Cancer.

[10]  P. Walsh,et al.  Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. , 1994, JAMA.

[11]  M. Irwin,et al.  Identification of insignificant prostate cancers: analysis of preoperative parameters. , 1994, Urology.

[12]  A. Partin,et al.  Small high grade adenocarcinoma of the prostate in radical prostatectomy specimens performed for nonpalpable disease: pathogenetic and clinical implications. , 1994, The Journal of urology.

[13]  M W Kattan,et al.  Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. , 1996, The Journal of urology.

[14]  D. Bostwick,et al.  The definition and preoperative prediction of clinically insignificant prostate cancer. , 1996, JAMA.

[15]  L. Baert,et al.  Impalpable invisible stage T1c prostate cancer: characteristics and clinical relevance in 100 radical prostatectomy specimens--a different view. , 1997, The Journal of urology.

[16]  J. Cheville,et al.  Cancer volume of lymph node metastasis predicts progression in prostate cancer. , 1998, The American journal of surgical pathology.

[17]  D. Bostwick,et al.  Independent origin of multiple foci of prostatic intraepithelial neoplasia , 1998, Cancer.

[18]  D. Chan,et al.  Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. , 1998, The Journal of urology.

[19]  L. Liotta,et al.  Evidence of independent origin of multiple tumors from patients with prostate cancer. , 1998, Journal of the National Cancer Institute.

[20]  C. Roehrborn,et al.  Prospective randomized comparison of high energy transurethral microwave thermotherapy versus alpha-blocker treatment of patients with benign prostatic hyperplasia. , 1999, The Journal of urology.

[21]  T. Stamey,et al.  Biological determinants of cancer progression in men with prostate cancer. , 1999, JAMA.

[22]  M. Marberger,et al.  Predictability and significance of multifocal prostate cancer in the radical prostatectomy specimen. , 1999, Techniques in urology.

[23]  C. Pan,et al.  The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. , 2000, The American journal of surgical pathology.

[24]  D. Bostwick,et al.  Preoperative prediction of surgical margin status in patients with prostate cancer treated by radical prostatectomy. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  T. Stamey,et al.  Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. , 2001, The Journal of urology.

[26]  J. Epstein,et al.  Does increased needle biopsy sampling of the prostate detect a higher number of potentially insignificant tumors? , 2001, The Journal of urology.

[27]  Liang Cheng,et al.  Predicting tumor volume in radical prostatectomy specimens from patients with prostate cancer. , 2003, American journal of clinical pathology.

[28]  M. Graefen,et al.  Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. , 2003, European urology.

[29]  Liang Cheng,et al.  Does pT2b prostate carcinoma exist? Critical appraisal of the 2002 TNM classification of prostate carcinoma , 2004, Cancer.

[30]  Paul W Dickman,et al.  Natural history of early, localized prostate cancer. , 2004, JAMA.

[31]  A. Jemal,et al.  Cancer Statistics, 2005 , 2005, CA: a cancer journal for clinicians.

[32]  Liang Cheng,et al.  The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[33]  Liang Cheng,et al.  Preoperative prediction of Gleason grade in radical prostatectomy specimens: the influence of different Gleason grades from multiple positive biopsy sites , 2005, Modern Pathology.

[34]  Liang Cheng,et al.  Closest Distance Between Tumor and Resection Margin in Radical Prostatectomy Specimens: Lack of Prognostic Significance , 2005, The American journal of surgical pathology.

[35]  Christopher K. Poulos,et al.  Preoperative prediction of small volume cancer (less than 0.5 ml) in radical prostatectomy specimens. , 2005, The Journal of urology.