Evaluating early-stage prostate cancer. What pretreatment criteria best guide therapeutic decision making?

Although much has been learned about clinically localized PCa, no single prognostic parameter has been identified that is uniquely reliable in assessing prognosis. The best approach to the newly diagnosed PCa patient remains unchanged: to review all the clinical, radiologic, and histopathologic findings together. In combination, the serum PSA level and the histologic features of a tumor on biopsy can be used to predict the likelihood that a tumor is organ-confined or has spread beyond the gland. By this approach, some patients may be placed into a low-risk category for which "watchful waiting" may be a reasonable option. For other patients, the benefit from this approach is in making more informed decisions concerning definitive therapy and/or the use of adjuvant therapy. The role of the surgical pathologist is to provide as much information as possible regarding the amount, location, and differentiation of tumor present in biopsy and TUR specimens. Prognostic interpretation of these histopathologic findings depends on good communication between pathologists and urologists, oncologists, and radiation oncologists, which remains a cornerstone in therapeutic decision making.