Single small focus of prostate adenocarcinoma (< or = 1 mm and too small for grading) and clinical significant disease after radical prostatectomy

Objectives: To determine whether a clinical significant adenocarcinoma of the cinoma (defined as a lesion &lt; or =1 mm. and too small for grading) at needle biopsy, even repeated, and through prostate specific antigen (PSA), PSA density (PSAD) and free-to-total PSA ratio (f/t ratio). Methods: Retrospectively 79/1610 consecutive patients undergoing prostatic needle biopsies presented one small focus of prostatic adenocarcinoma &lt; or =1 mm and too small for grading. All patients underwent PSA, PSAD and f/t ratio to evaluate positive predictive value for clinically significant disease. All patients were submitted to radical retropubic prostatectomy (RRP) and were divided into three groups: group A (28/79 patients, 35.4%) submitted to RRP after diagnosis of just one small focus of adenocarcinoma at first biopsy; group B (26/79 patients, 32.9%) submitted to RRP after two successive diagnoses of small focus of adenocarcinoma; group C (25/79 patients, 31.6%) submitted to RRP after diagnosis of adenocarcinoma larger than 1 mm at successive biopsy in which Gleason score had been applied. Results: The three groups resulted comparable for age, PSA, f/t ratio and PSAD. Clinically significant disease was found in 48 of 79 patients (60.7%); 16 patients of group A (33.3%), 15 patients of group B (31.2%) and 17 patients of group C (35.4%) respectively. Finally, PSA, f/t ratio, and PSAD showed no predictive value neither globally nor in the single groups. Conclusions: No selective criteria with consolidated predictive values emerge from our study and this is in agreement with data in the literature, where the risk to find no significant clinical disease is 9-48% approximately. The aim of this retrospective study is to analyze the correlation between a single small focus of adenocarcinoma by prostatic biopsy, even repeated, and the clinical significant disease on the following radical retropubic prostatectomy. Furthermore, we verified whether some preoperative parameters could be helpful to identify the subgroups of patients which could need a more or less aggressive and/or timely treatment. Our data show that 30-40% of patients did not harbor a clinically significant disease at the following RRP. Furthermore, the assumed predictive value of repeat biopsies has not been confirmed in these patients and no other preoperative predictive values can be helpful.