Clinical outcome of patients with stage T1a prostate cancer.

Background: The prognosis and proper treatment of stage T1a prostate cancer remain unsettled. The aim of the study was to identify retrospectively some predictors of disease progression in stage T1a prostate cancer.
Methods: We reported on 52 patients with stage T1a prostate cancer diagnosed between 1983 and 1996 at Taichung Veterans General Hospital. The recorded clinical follow-up, pathological staging and treatment of these patients were reviewed. Disease progression is defined as progressive elevation of the serum PSA value and proved by transrectal needle biopsy of the prostate or the appearance of metastatic disease. All original surgical pathology material from each patient was reviewed by a single pathologist and graded by the Gleason system.
Results: The mean age of patients with T1a prostate cancer at diagnosis was 71.5 +/- 7 years old. During the median follow-up of 7.3 years (range, 0.5 to 15 years), four patients (7.7%) developed disease progression. Twenty-one patients died due to other causes and no patient died due to prostate cancer. It was statistically significant that the patient with pathological Gleason score > or = 5 had positive correlation with disease progression.
Conclusions: The clinical course of stage T1a prostate cancer is variable. The presence of Gleason score > or = 5 in pathological report is usually associated with cancer progression. More aggressive treatment including radical prostatectomy or local radiotherapy is advised in those selected high risk patients with a long life expectancy. Patients with tumor Gleason score < 5 have a low risk of disease progression and can be managed conservatively; but they should remain under observation indefinitely.