The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Abstract

Clinically localized prostate cancer is associated with a wide variation in biologic behavior, and men with the less aggressive form of the disease may never develop symptoms. There has been a rise in prostate cancer incidence in countries in which the blood test for prostatic-specific antigen (PSA) is common, and concerns have been expressed that this may be because of the increased detection of indolent disease, subjecting these men to unnecessary treatment and associated side effects. For the current review, the authors conducted a systematic evaluation of the literature regarding the outcomes of men who were diagnosed on the basis of a small volume of cancer in prostatic biopsies. The results indicated that, despite differences in study design and reporting, a significant proportion of patients with microfocal cancer, regardless of how it was defined, had adverse pathologic findings and a significant risk of PSA recurrence after undergoing radical prostatectomy. Biochemical and clinical recurrences also were observed after radiotherapy or watchful waiting. The authors concluded that patients with microfocal carcinoma on biopsy should be advised that their disease is not necessarily ''insignificant'' and should be counseled accordingly. Cancer 2008; 112:971-81.

Performance Characteristics of MR Imaging in the Evaluation of Clinically Low-Risk Prostate Cancer: A Prospective Study

“…For lesions of 0.5 cm 3 and ,1 cm 3 , sensitivities were significantly lower when the lesion Gleason score was 6 (0. …”

“…The sensitivity of MR spectroscopic imaging in detecting lesions of 0.5 cm 3 or greater was consistently lower than that of T2-weighted imaging and was not significantly affected by tumor volume or Gleason score (Tables 3, 5).…”

“…Detection of index lesions.-For T2-weighted imaging, sensitivities for detecting index lesions of 0.5 cm 3 …”

“…Statistical analyses were done at the sextant level and, for individual lesions of 0.5 cm 3 or greater, at the lesion level. Readers' T2-weighted imaging scores …”

“…Between December 2005 and November 2009, 358 patients gave informed consent to be enrolled in a prospective Institutional Review Board-approved National Institutes of Health study investigating the use of pretreatment MR imaging and MR spectroscopic imaging for assessing clinically low-risk prostate cancer (clinical stage T1c-T2a, Gleason than expected (3,4). Conversely, many patients with clinically low-risk prostate cancer harbor clinically insignificant disease that may never require treatment (5).…”