Significance Of Minute Focus Of Adenocarcinoma On Prostate Needle Biopsy

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Urology / Nephrology
Article Date: 23 Dec 2007 - 0:00 PDT

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UroToday.com- In a screened prostate cancer (CaP) population, it has been reported that a minute focus of CaP on biopsy is associated with clinically significant CaP on radical prostatectomy (RP) in only 33% of cases. In the August issue of Urology, Dr. Samaratunga and colleagues from Australia investigated the association of a minute focus of CaP on biopsy in an unscreened population. They found pathologically significant CaP in the RP specimen in 83% of these men.

In Australia, population-based screening for CaP in asymptomatic men is not recommended. Men between ages 40-70 can request PSA testing, especially if they have a positive family history. Between 2002 and 2005, a single pathology group database identified 136 men with a minute focus (0.5mm or less) of Gleason <6 CaP on prostate biopsy. Of these 136 men, 58 underwent RP and serve as the study population. Clinical and pathologic data was assessed. CaP that was potentially clinically insignificant was defined as organ-confined with a volume of <0.5cc with a Gleason score of <6 at RP.

The 136 identified men accounted for 2.8% of the total 4,657 CaP cases diagnosed during the time frame in this database. The mean patient age of the 58 men undergoing surgery was 50 years and the mean PSA was 6.9ng/ml. Four of the 58 had a stage T2 disease based on rectal examination. The mean number of biopsy cores was 11 and 48 of the 58 men had at least 8 or more cores taken. Prior negative biopsies, concurrent high-grade PIN, and concurrent small foci of atypical glands were found in 12, 30 and 11 men, respectively.

Pathologically, at RP all tumors were found in the peripheral zone and mean tumor volume was 2.3cc. Of the 58 men, 48 (83%) had pathologically significant tumors and 8 (14%) had extra-prostatic extension. Distribution of pathological stage was pT2 in 48, pT3 in 8 and 2 with capsular incision. Gleason score was 6 (3+3) in 39, 7 (3+4) in 15, 7 (4+3) in 1, 8 (4+4) in 1, and 7 with a tertiary component of 5 in 2 men. Surgical margins were focally positive in 5 patients with pT3 disease and in 2 with capsular incision. The authors found the only statistically significant association was between a larger prostate size and increased probability of potentially insignificant cancer.

Samaratunga H, Yaxley J, Kerr K, McClymont K, Duffy D

Urol. 70(2): 299- 302, August 2007
doi:10.1016/j.urology.2007.03.068

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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