Zur klinischen Insignifikanz des Prostatakarzinoms : Gibt es morphologische Hinweise? (Originalien)

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