Does Detection of Small-Volume Prostatic Adenocarcinoma by Ultrasound or Magnetic Resonance Imaging Provide Improvement in Disease Control?

Abstract

The other chapters in this book deal with the problem of microscopic prostatic malignancy, focusing on the biologic course of stage A focal disease.The subject of this chapter allows me to defer discussion on this problem as neither ultrasound nor magnetic resonance imaging is able to detect microscopic foci of prostatic carcinoma, the limits of resolution of detection approximately 1 cm³ of malignancy. Therefore, to argue the topic effectively, I must examine the impact of definitive treatment in stage A and stage B (T1, T2) disease. The hypothesis proposed is that stage A and stage B disease are identical in biologic risk and that the staging classification is an artificial one. The argument is directed to the premise that, in today’s world with new imaging techniques which permit the identification of malignancy in prostates with no digitally palpable abnormality, the stages T1 and T2 should be discarded and replaced by volumetric assessments, perhaps modified by either histopathologic grade or nuclear ploidy. To accomplish this goal, let us first examine the clinical course of patients with stage A prostatic carcinoma treated by radical prostatectomy, then examine the relative clinical outcome of patients with stage A and stage B disease treated by radical prostatectomy, and lastly, compare the outcome of stage A and stage B patients as a function of both volume of disease and histopathologic grade.