Distribution of carcinoma in radical prostatectomy specimens in the era of serum prostate-specific antigen testing. Implications for delivery of localized therapy.

Prior studies documenting the distribution of cancer in radical prostatectomy specimens were based on specimens resected before the advent of prostate-specific antigen (PSA) testing and were not specifically aimed at defining the incidence of cancer in precise regions of the gland. If localized therapy, such as brachytherapy or conformal radiation, could be minimized in areas of low cancer incidence, such as the anterior prostate, morbidity including injury to adjacent normal tissue might also be minimized. We examined 82 recent prostatectomy specimens and noted all areas of cancer in each gland. Distribution of involvement was evaluated with respect to preoperative serum PSA level, clinical stage, and pathologic features. Prostate cancer was present posteriorly in 78 of 82 cases and anteriorly in 53 of 82 cases. The presence of anterior cancer was strongly associated with elevated PSA level (P = .003), total cancer volume (P = .0002), and extraprostatic extension (P = .006), but was not associated with age, Gleason grade, or clinical stage. We conclude that the incidence of anterior prostate cancer is high. Its presence is strongly correlated with other variables, and thus strategies for selecting patients for limited localized therapy based on preoperative PSA and tumor volume estimates may be warranted.