A Clinicopathologic Study of Preoperative and Postoperative Findings with Minute Gleason 3+3=6 Cancer at Radical Prostatectomy

Objectives: One would expect cases with small foci of cancer at radical prostatectomy to be associated with correspondingly favorable (Gleason score ≤6, <3 positive cores, no core with greater than 50% cancer) biopsy and preoperative clinical findings. Methods: Radical prostatectomies from The Johns Hopkins Hospital (July 2004 to July 2006) with only 1 to 3 slides involved by 3+3=6 adenocarcinoma of the prostate with no focus of cancer measuring greater than 2 mm in dimension were identified. Results: One hundred fifty-one radical prostatectomy specimens were obtained with cancer involving 1 slide in 69 cases (45.7%), 2 slides in 61 cases (40.4%), and 3 slides in 21 cases (13.9%). Predominantly transition zone cancer was present in 1 patient (0.66%). Mean patient age was 57.1 years (41 to 73 years). Twenty-two patients (14.6%) had a suspicious digital rectal examination. Mean serum prostate-specific antigen (PSA) and percentage free PSA were 5.2 ng/dL (0.3 to 16.7 ng/dL) and 15.5% (8% to 36%), respectively. Of 146, 127 (87%) men with available information had PSA density of less than 0.15. Mean number of cores obtained was 12 (4 to 27 cores) and all were Gleason 3+3=6 cancers on biopsy. One hundred fourteen cases (75.5%) had 1 core positive, 28 cases (18.5%) 2 cores, and 9 cases (6%) had 3 or more cores positive. One hundred forty-eight cases (98%) had cancer involving 50% or less of 1 core; 2 of these cases with greater than 50% cancer were discontinuous foci. Conclusions: Although, typically, biopsy and clinical preoperative findings associated with very limited cancer at radical prostatectomy are correspondingly favorable, exceptions occur in terms of biopsy cancer extent, serum PSA measurements, and digital rectal examination findings.