Incidental Prostate Cancer: Predictors of Progression

Abstract

Incidental prostate cancer found in prostatectomy specimens removed for supposedly benign disease presents the clinician with a difficult management decision. While the majority of these lesions manifest a low biologic potential with little impact on the patient, a substantial number are aggressive tumors significantly affecting survival. Appropriate management requires accurate prediction of probable risk in selecting treatment. Incorrect predictions expose the patient considered at increased risk to the potential and unnecessary morbidity of additional therapy, while those presumed at minimal risk may have potentially curative treatment withheld. The variable behavior of incidental prostate cancer and the lack of adequate predictive parameters stimulated widespread controversy regarding management, which diminished after Jewett’s proposal in 1975 that these lesions be classified as A1, low grade and focal, or A2, high grade and diffuse [1].