Testicular carcinomas, pediatric tumors, and some mesenchymal tumors are examples of rapidly proliferating cell populations, for which the tumor volume doubling time (TVDT) can be counted in days. Cancers from the breast, prostate, and colon are frequently slow‐growing, displaying a TVDT of months or years. Irrespective of their growth rates, most human tumors have been found: to start from one single cell, to have a long subclinical period, to grow at constant rates for long periods of time, to start to metastasize often even before the primary is detected, and to have metastases that often grow at approximately the same rate as the primary tumor. The recognition of basic facts in tumor cell kinetics is essential in the evaluation of important present‐day strategies in oncology. Among the facts emphasized in this review are: (1) Screening programs. Most tumors are several years old when detectable by present‐day diagnostic methods. This makes the term “early detection” questionable. (2) Legal trials. The importance of so‐called doctor's delay is often discussed, but the prognostic value of “early” detection is overestimated. (3) Analyses of clinical trials. Such analysis may be differentiated depending on the growth rates of the type of tumor studied. Furthermore, uncritical analysis of survival data may be misleading if the TVDT is not taken into consideration. (4) Analyses of epidemiological data. If causes of malignant tumors in humans are searched for, the time of exposure must be extended far back in the subject's history. (5) Risk estimations by insurance companies. For the majority of human cancers, the 5‐year survival rate is not a valid measurement for cure. Thus, basic knowledge of tumor kinetics may have important implications for political health programs, legal trials, medical science, and insurance policies. J. Surg. Oncol. 1997;65:284–297. © 1997 Wiley‐Liss, Inc.

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Objectives To further characterize patterns of tumour significantly larger in multifocal cases with an index tumour volume of >3 mL than in unifocal tumours growth and the distribution of markers for the aggressiveness of prostate cancer by assessing the relation->3 mL (P<0.05). Small volume, unifocal tumours had little PIN. The most malignant features of each ships among the volume of the 'index' tumour and that of the remaining foci, with pathological (pT) case were always represented in the index tumour but not generally in the remaining foci. stage, histological grade and DNA ploidy, and with the amount of low-and high-grade prostatic intraepiConclusions The volume distribution, related to multicentricity and its concomitant PIN volumes, indicates thelial neoplasia (PIN). Materials and methods Eighty-eight step-sectioned total that large index tumours, uni-or multifocal, of medium or high grade, are associated with low PIN prostatectomy specimens were analysed. The Gleason score, tumour stage and DNA ploidy (by flow cytomvolumes. However, multifocal medium-and highgrade tumours with small index tumour volumes have etry) of multiple samples were determined. Tumour and PIN areas were outlined and their volumes estihigher PIN volumes. Small, single tumours are of lowgrade and may represent the slowly progressing canmated by computerized planimetry. Results The pT stage, Gleason sum and DNA noncers possibly resembling those found in autopsy studies. diploidy increased, and PIN volumes decreased, with increasing volume of the index tumour focus Keywords Prostate cancer, radical prostatectomy, morphometry, prostatic intraepithelial neoplasia (PIN) (P<0.01), but did not diÂer significantly between uniand multifocal tumours. However, PIN volumes were most cancerous prostate glands [15]. It has been claimed Introduction that high-grade PIN is a strong risk factor for the occurrence of cancer, whereas low-grade PIN has not There are many prognostic factors related to tumour features in patients with localized prostatic cancer and been shown to be an independent risk [16][17][18][19]. The PIN-volume (low-and high-grade) is inversely correlated the individual validity of these factors is debated. The prognostic value of histological grade is well established with the volume of cancer, i.e. more cancer in a gland gives relatively less PIN. Single-cell image cytometry in prostatic cancer, as in most other malignancies [1][2][3]. The pathological (pT) stage, including seminal vesicle [20,21] has shown that PIN may be largely aneuploid, although less so than the concomitant carcinomas, invasion and positive surgical margins, is a recognized indicator of poor prognosis [4]. Tumours which penetrate contrary to flow cytometric studies showing PIN as mostly diploid [12,15]. Autopsy studies show that lowthe 'capsule' (i.e. the condensed fibrous pseudocapsule) of the prostate have a significantly worse prognosis than grade PIN often precedes cancer by at least 10 years [22,23], but the spatial relationship with invasive cancer '...

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