Springer Online Journal Archives 1860-2000
Summary A retrospective study of 55 patients with incidental prostatic carcinoma with long term follow-up is presented. All patients were treated with total perineal prostatectomy, 43 received some form of endocrine treatment after the initial diagnosis was made. In order to contribute to the establishment of low and high risk groups which do not or do require agressive treatment, a careful histological analysis of the 39 patients was carried out on whom total prostatectomy slides with tumor were available. The amount of tumor, grade and parameters commonly used to establish grading were determined and correlated with corrected survival. The findings indicate that a small amount of tumor, grade 1, the presence of small, intermediate or large glands (but not cribriform and/or solid tumor) and the presence of slight but not moderate or marked variation in size and shape of the nucleus are strong predictors of not dying from prostatic carcinoma. There is agreement with the literature, where similar groups of patients not further treated after the initial diagnosis had been established showed a comparably low number of progressions. It is concluded that small, well differentiated prostatic carcinomas (category T0pT1NxM0G1, stage A1) do not require an aggressive diagnostic work-up or further treatment. A group of 11 patients (27%) showed more extensive but well differentiated tumors. Only two of these patients died of prostatic carcinoma. The natural history of this entity is not sufficiently known to make definite treatment decisions. Staging, radical prostatectomy, radiotherapy or deferred treatment may be indicated. Grade 3 carcinoma or the presence of cribriform and/or solid tumor were strong predictors of progression and death from prostatic carcinoma. Seven of 14 patients with these characteristics died of their disease. It is concluded that at least the experience in this series does not show radical prostatectomy to be an optimal treatment in this group of patients. Smaller rates of progression are however described in the literature. Endocrine management does not seem to have any beneficial effect, reports on radiotherapy are scarce. The optimal treatment for this group of patients with a high risk of dying from their tumor and a significantly shortened overall survival is not known.
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