Incidental Carcinoma of the Prostate: a Review of the Literature and Critical Reappraisal of Classification

Abstract

The problem in treating incidental carcinoma of the prostate is that of distinguishing between tumors that will have a long, benign natural history and those that will progress rapidly. A review of the English literature concerning incidental prostatic carcinoma reveals that patients with focal low grade tumors have a good prognosis, while patients with high grade lesions often suffer rapid tumor progression. By contrast, the clinical significance of high volume, low grade tumor is unknown. A method has been developed to evaluate the distribution of prostatic cancer using 4-quadrant transurethral prostatic resection. A detailed method for staging these cancers based on a comprehensive, segmental histopathological analysis also is presented. A precise definition of the stages of prostatic cancer should eventually improve our understanding of the natural history of this disease.

Suppressive effects of antiandrogens, finasteride and flutamide on development of prostatic lesions in a transgenic rat model

“…1 Over 60% of these newly diagnosed cases of prostate cancer will be pathologically advanced; at this stage, there is no cure and the prognosis is dismal. Since the frequency of latent prostatic tumors has been shown to increase with each decade of life from the 50s (5.3-14%) to the 90s (40-80%) 2 and relatively long time periods are necessary for progression to actual prostate cancer, the concept of chemoprevention has attracted much attention.…”

Proliferative response of human prostate tumour xenografts to surgical trauma and the transurethral resection of the prostate controversy

“…An astonishingly high prevalence of what pathologists have interpreted as microscopic foci of well-differentiated adenocarcinoma has been found at autopsy in serial sections of prostate glands considered to be normal from men over the age of 50. Every decade of ageing nearly doubles the incidence of such tumours -from 10% in men in their 50s to 70% in men in their 80s (Scott et al, 1969;Sheldon et al, 1980). Such a prevalence of 'latent' or 'incidental' tumours appears to be unique to the prostate gland (Silverberg and Lubera, 1989).…”

Prostate cancer: a hazard also to be considered in the ageing male patient with spinal cord injury

“…A decisive factor associated with progression of the disease and decreased survival would seem to be the degree of di erentiation of the neoplasm: there would seem to be su cient data to merit aggressive therapy in most cases of high grade lesions 14 as found in our patient. However the curability of this grade of tumor is not uncommonly much more uncertain than one would hope and understaging during diagnosis proves not unfrequent.…”

“…The incidence of such tumors increases with age from up to 14% at 50 ± 60 years to up to 80% in men over 90. 14 Incidental prostatic carcinoma is a poorly understood tumor. It is still an open question today how to determine if a localized prostate cancer discovered on screening or by accident will remain clinically silent or not.…”