Prognosis of Incidental Prostatic Cancer in Aust-Agder County, Norway

Abstract

The clinical significance of dividing incidental prostatic cancer into T0 focal (A1) and T0 diffuse (A2) is well documented, but criteria for the distinction vary considerably. Eighty-four patients with incidental prostatic cancer over a 5-year period comprise all newly diagnosed cases from an area of 94,000 inhabitants in the Aust-Agder County in Norway. This represents 13% of the patients operated upon for apparently benign prostatic hyperplasia. Of these patients, 80 with a mean age of 73.9 years did not receive any additional treatment after prostatectomy until progression (deferred treatment) and were followed up for 2-7 years. Three chips or less of well-differentiated cancer were defined as T0 focal (n = 18), all other cases were T0 diffuse (n = 62). Sixty-nine patients (86%) were free of progression. Eighteen patients died of causes unrelated to prostatic cancer. Progression occurred in 11 patients (14%) at a mean time interval of 39 months after diagnosis, and 3 patients died of prostatic cancer. Related to grade, progression occurred in 2% of the G1 tumors, in 25% of G2, and in 40% of the G3 tumors. When a tumor volume of 25% was chosen as level of distinction between T0 focal and T0 diffuse, 25 patients (31%) changed the stage to T0 focal without any impact on prognosis.