PSA-detected prostate cancer: contrasts with palpable disease

The clinical and pathologic characteristics of 100 consecutive men with clinically localized prostate cancer and staged by radical prostatectomy were reviewed. Men with impalpable prostate-specific antigen (PSA) detected cancers (T1c) were contrasted against men with palpable disease (TB). Lesions were clinically staged as T1c in 53 men and TB in 47 men. Mean serum PSA for men with T1c cancers was 11.8 +/- 0.7 ng/dL (normal: 0 > 4) and 14.1 +/- 1.7 ng/dL for men with TB disease. Histologic evaluation revealed a mean Gleason's sum of 6.4 +/- 0.2 (scale: 2 > 10) for T1c lesions and 6.6 +/- 0.2 for men with TB cancers (P = NS). DNA content was diploid in 67% of T1c cancers and 62% of TB lesions (P = NS). An overall 43% clinical staging error was observed. Extraprostatic extension was demonstrated in 36% of T1c cancers and 51% TB lesions (P = NS). PSA-detected cancers were indistinguishable from palpable lesions by all measures evaluated. Prostate cancers detected in asymptomatic men by an elevated PSA should be considered biologically significant lesions.