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Prostate cancer detection: relationship to prostate size
M E Chen1, P Troncoso, D Johnston
1Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Urology
|April 10, 1999
Summary
Large prostates have a lower cancer detection rate because they contain more small-volume tumors. Increasing biopsy cores for larger glands may detect more low-progression cancers.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Prostate cancer detection rates can be lower in larger prostates.
- This may be due to a smaller proportion of sampled tissue relative to gland size.
Purpose of the Study:
- To investigate the relationship between prostate gland volume and cancer volume.
- To simulate prostate biopsies and assess cancer detection likelihood based on gland size and tumor volume.
Main Methods:
- Whole-mount radical prostatectomy specimens were analyzed.
- Cancer and gland volumes were determined using planimetry and weighing.
- Computer simulations of parasagittal sextant biopsies were performed on digitized prostatectomy specimens.
Main Results:
- Small-volume cancers (<0.5 cc) were more frequent in larger glands (>50 g).
- Simulated biopsy detection rates were lower in larger glands (48% vs. 67%).
- Detection rates for small cancers (<0.5 cc) were significantly lower (18%) compared to larger cancers (>0.5 cc) (73%).
Conclusions:
- Lower cancer detection in large prostates is linked to a higher prevalence of low-volume tumors.
- Elevated PSA in large glands may stem from benign tissue, leading to unnecessary biopsies.
- Increasing biopsy cores based solely on prostate size may overdetect indolent, small-volume cancers.