Role of Histology in Selecting Treatment for Stage A₁ and Stage A₂ Disease

Abstract

The question posed is based on the assumption that the biologic risk of clinically unsuspected prostatic adenocarcinoma is sufficiently well defined as to permit treatment decisions to be made as a function of histologic grade and perceived local volume of the malignancy. Unfortunately, the published series which examine occult prostatic malignancy in an attempt to predict outcome are distorted due to variation in classification of focal and diffuse, and biologic risk is distorted due to uncontrolled use of various treatments. (1–8) One published series does much to define the clinical course of low volume, low histopathologic grade prostatic malignancy. (3,9) The series is unique in that the population was untreated until progression. Cantrell and associates identified 82 patients with clinically unsuspected disease and segregated these into two populations, A₁ and A₂, based on volume and histopathologic grade of the resected prostatic tissue. (10) A₁ tumors were ≤ 5 percent of the volume of resected tissue and were ≤ Gleason histopathologic sum of 7. The population segregated into 48 A₁ patients and 34 A₂ patients. Followed for 48 months from diagnosis without treatment, 1 of 48 A₁ tumors recurred while 11 of 34 A₂ tumors recurred or progressed. Cantrell excluded all high grade (Gleason 8, 9, 10) tumors from Stage A₁.