[Clinical and biological progression of incidental prostatic cancer ( Stage T 1a)]

[Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH]

OBJECTIVES-INTRODUCTION: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy -APS-, and prostate transurethral resection -RTU-P-) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected.

MATERIAL AND METHODS

1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI.

RESULTS

78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8-30). Gleason average 5 (mean 4.8), rank 3-8. pTla 66%, pTlb 33%.

TREATMENT

57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients).

CONCLUSIONS

We didn't observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pTla. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%.

Cáncer de próstata incidental: T1a-T1b. Nuestra experiencia tras observación/intervención radical y revisión de la literatura

OBJECTIVES

To analyse the progress of T1a and T1b prostate cancer diagnosed in our hospital.

MATERIAL AND METHODS

Retrospective study of 40 patients in T1a-T1b clinical stage diagnosed with prostate adenocarcinoma in our hospital, from 1986 to 1999. A restaging biopsy was performed on the 16 T1a patients after initial diagnosis and control. A radical prostatectomy was performed on the 24 T1b patients. They were all monitored every six months with rectal exam and PSA. We analysed biological and/or clinical progression, time to progression, mortality caused by the tumour and survival.

RESULTS

None of the 16 patients with T1a clinical stage presented tumour progression, with a median follow-up of 90 months. 12,5% of the 24 T1b cases presented tumour progression, with a median follow-up of 70 months. Cancer-specific mortality was one patient (4,16 %) in the T1b group.

CONCLUSIONS

Observation and follow-up with PSA and rectal exam appears to be a good option for T1a clinical stage, given the good prognosis. Our results show that patients with T1a clinical stage and good prognostic factors could be at a similar risk of suffering from a new prostate cancer as the normal population, although prospective studies are required to validate these results. T1b cases require active treatment and closer monitoring.