[Prostatic carcinoma. Incidence and significance of stage I - preclinical carcinoma]

58 consecutive prostatic glands of men without clinical prostatic cancer were investigated. In 40% of all over 50-year-old men (average age: 76 years) a prostatic cancer was found. The macroscopic diagnosis of stage I prostatic cancer was found to be unreliable. Since in routine necropsies the first and decisive evaluation of the prostate is based on macroscopic findings, most prostatic cancers are missed and only 3% are found on an average. To detect prostatic cancer with a minimal diameter of 3 mm reliably, 10-15 large histologic slides have to be investigated. The tumor size, the nuclear polymorphism, the frequency of perineural invasion and the number of inflammatory cells increase with histologic dedifferentiation. The results support the hypothesis, that the clinical prostatic cancer is in fact an enlarged, dedifferentiated stage I cancer. The clinical significance of stage I prostatic cancer is rather small because of the advanced age of the patients. Most of the patients die before the cancer becomes clinical.