Abstract

OBJECTIVE:

Overdiagnosis and overtreatment of microfocal nonpalpable and early-stage prostatic adenocarcinoma are currently a topic of strong discussion. We tried to find morphological findings of such insignificant carcinomas of the prostate.

STUDY DESIGN:

More than 1,000 consecutive core needle biopsy specimens of prostate carcinoma taken during 1 year (2007) were graded according to the modified Gleason scoring system. The results were correlated to serum prostate-specific antigen (PSA) and tumor extent in the cores.

RESULTS:

Cases with PSA <10 ng/ml and tumor extent <20% frequently (up to 55%) had Gleason scores of 6 or 7a. Cases with PSA >10 ng/ml or tumor extent >20% had higher Gleason scores (>7a). Cancers with tumor infiltration of <1 mm in one of up to 12 cores and PSA <10 ng/ml mainly had low Gleason scores (6 and 7a), but only 5% of the carcinomas in the studied specimens corresponded to such a parameter. Only 25% of such patients had a pT2a tumor after radical prostatectomy.

CONCLUSION:

With a very restricted parameter of a microfocal adenocarcinoma of the prostate with a Gleason score <7a, tumor infiltration of <or=1 mm in only one core needle biopsy, and PSA of <or=10 ng/ml, clinical insignificance may be possible, and in agreement with the patient, active surveillance is feasible. However, such cases are rare.