Pathological factors that influence prognosis in stage A prostatic cancer: the influence of extent versus grade

To determine the pathologic factors useful in predicting prognosis in patients with stage A prostatic cancer we studied 117 patients followed for 2 to 15 years. Since no patient was treated until progression of disease occurred we were able to correlate pathologic findings with the natural history of the disease in an untreated population of patients. In 14 patients (12 per cent) extensive local (2) or metastatic (12) disease developed. Because 12 of the 14 patients had progression of the disease within 4 years we thought than an analysis of all patients followed for 4 years would be useful. Extent and grade of disease were the 2 factors that most accurately predicted progression. No patient with a low grade lesion (Hopkins grade 1 or Gleason total score 2 to 4) had progression and only 2 per cent of patients with less than 5 per cent cancer had progression. These patients were classified as stage A1 and 60 per cent of all patients were in this category. We believe that these patients require no further therapy. Of the patients with more than 5 per cent cancer 32 per cent had progression and 17 per cent of the patients with either Hopkins grade 2 to 3 disease or Gleason total score more than 4 had progression. These patients were classified as stage A2 and their optimal management remains to be determined.