Incidental carcinoma of the prostate: selection for deferred treatment

Fifty-one of 212 consecutive patients with prostatic cancer presented with incidentally diagnosed (TO) cancer. The average age at presentation was 73 years and follow-up ranged from 1 to 62 months. Deferred treatment was selected in 39 cases, 10 of which progressed. Of 15 deaths only 3 were related to prostate cancer and these were patients who had presented with metastases. Histological grading by the Gleason system demonstrated a significant correlation with metastatic stage at presentation and tumour bulk, but not with age or progression in deferred treatment cases. It is concluded that there is a need to subdivide patients presenting with incidental carcinoma, that tumour bulk correlates with histological grade and that future treatment protocols for TO disease should stratify for histological grade.