Surgical Treatment of Stage A2 Prostatic Carcinoma: Significance of Tumor Grade and Extent

Optimal management of men with diffuse incidental prostatic cancer (Stage A2) is an unresolved issue. Current forms of therapy include radical prostatectomy, external beam radiation therapy, and no treatment. Long-term results with curative therapy have been unreported because of the relatively recent substaging of Stage A into incidental and diffuse disease. The results of radical prostatectomy in 25 patients with Stage A2 prostatic cancer were reviewed. Incontinence was the most serious complication and occurred in four patients (16%). Pathologically, 24 patients (96%) had residual carcinoma present in the radical prostatectomy specimen. In 22 men (88%) the tumor was entirely confined to the prostate. Two patients (8%) demonstrated seminal vesicle invasion, and one (4%) had capsular penetration. In follow-up metastatic disease has developed in one patient, and another died without evidence of cancer. The remaining patients are alive without evidence of disease. Since 88% of men with Stage A2 disease have their tumor entirely confined to the prostate, radical prostatectomy offers an excellent chance of long-term cure, as in Stage B prostatic cancer.

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Efficacy of radical prostatectomy for stage A2 carcinoma of the prostate

Elder

Gibbons

Correa

et al. 1985

Cancer

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The role of radical prostatectomy in the management of prostatic cancer

Walsh

Lepor

1987

Cancer

110

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The indications for radical prostatectomy must reflect the following: an understanding of the natural history of the disease, the projected life span of the patient, the stage of the disease, and the relative morbidity and efficacy of alternative therapeutic regimens. The integration of clinical stage, histologic grade, and pelvic lymph node evaluation has improved the selection of the ideal candidate for radical prostatectomy. In men with localized disease, there is no evidence that any treatment other than radical prostatectomy produces better control of the primary lesion and of distant metastases than does total surgical excision of the prostate. Recently the morbidity of radical prostatectomy has been reduced by improvements in surgical technique. Intraoperative identification and preservation of the branches of the pelvic plexus that innervate the corpora cavernosa has resulted in long-term postoperative potency rates of 70% without compromising complete excision of the tumor. Thus it appears possible today to preserve sexual function in a majority of patients undergoing radical prostatectomy without compromising the cancer operation, an observation that may encourage more physicians to take greater interest in diagnosing prostatic cancer in young men at a stage when it is still curable.

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Pathologic findings in clinical stage A2 prostate cancer. Relation of tumor volume, grade, and location to pathologic stage

Christensen

Epstein

Partin

et al. 1990

Cancer

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Transurethral resections (TUR) and totally embedded radical prostatectomies from 39 clinical Stage A2 prostate cancers were morphometrically analyzed and compared with 56 prior similarly studied clinical Stage B cancers. All the clinical A2 radical prostatectomies contained residual tumor with 26% having capsular penetration. Clinical Stage A2 tumors were much more heterogeneous than clinical Stage B tumors with respect to tumor location, grade, and amount. In particular, many clinical A2 cases were predominantly central or central and anterior in location (59%) and low-grade compared with clinical Stage B cases where most lesions were posterior, peripheral, and intermediate grade. Percent of tumor in TUR best predicted final pathologic stage versus TUR grade or volume. Despite statistically significant correlations between tumor percent and/or grade on TUR and final stage, predictability of final stage for individual patients from TUR data was poor. The complex interrelation of tumor location, grade, and amount resulted in wide and overlapping ranges for these parameters for organ-confined and nonconfined cases.

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Surgical Treatment of Stage A2 Prostatic Carcinoma: Significance of Tumor Grade and Extent

Cited by 33 publications

References 13 publications

Efficacy of radical prostatectomy for stage A2 carcinoma of the prostate

Efficacy of radical prostatectomy for stage A2 carcinoma of the prostate

The role of radical prostatectomy in the management of prostatic cancer

Pathologic findings in clinical stage A2 prostate cancer. Relation of tumor volume, grade, and location to pathologic stage

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