[Prognostic parameters of locally confined prostate carcinoma]

Current methods for patient selection lack the necessary sensitivity and specificity for selecting those for whom cure is required and possible. Prognostic factors must be understood in the light of the nature of prostatic carcinoma and the actual direct benefit of the information to the patient. The absolute impact of prostate cancer at different ages and in all grades varies substantially as indicated by loss of life expectancy. Diagnostic tests are able to distinguish clinically unimportant cancers. Quantitative analysis of systematic biopsy specimens combined with PSA density provides valuable staging information and helps to identify cancers of low biological potential i.e. small (0.5 cm3 or less), well or moderately differentiated and confined to the prostate. The majority of the patients with a maximum cancer length of 2 mm or less and a PSA density of less than 0.1, do not need curative treatment. Multivariate analysis studies identified pathological grade and preoperative serum PSA concentration as independent predictors of clinical progression in up to 1/4 of patients with pathologically organ-confined prostate cancer after radical prostatectomy. Prognostic scoring systems are reported using the regression coefficients from the Cox multivariate model to classify patients further according to risk of progression.