Can a Gleason 6 or Less Microfocus of Prostate Cancer in One Biopsy and Prostate-Specific Antigen Level <10？ng/mL Be Defined as the Archetype of Low-Risk Prostate Disease?
Prostate cancer (PC) remains a cause of death worldwide. Here we investigate whether a single microfocus of PC at the biopsy (graded as Gleason 6 or less, ≤5% occupancy) and the PSA <10？ng/mL can define the archetype of low-risk prostate disease. 4500 consecutive patients were enrolled. Among them, 134 patients with a single micro-focus of PC were followed up, and the parameters influencing the biochemical relapse (BR) were analysed. Out of 134 patients, 94 had clinically significant disease, specifically in 74.26% of the patients with PSA <10？ng/mL. Positive surgical margins and the extracapsular invasion were found in 29.1% and 51.4% patients, respectively. BR was observed in 29.6% of the patients. Cox regression evidenced a correlation between the BR and Gleason grade at the retropubic radical prostatectomy (RRP), capsular invasion, and the presence of positive surgical margins. Multivariate regression analysis showed a statistically significant correlation between the presence of surgical margins at the RRP and BR. Considering a single micro-focus of PC at the biopsy and PSA serum level <10？ng/mL, clinically significant disease was found in 74.26% patients and only positive surgical margins are useful for predicting the BR. 1. Introduction Prostate cancer (PC) remains the most common cancer in men, and its prevalence in men aged >50 years has been estimated to be as high as 40% [1]. PC still represents the third leading cause of male cancer-related death, after lung and colorectal cancer [2], but the majority of cases are nonlethal [3]. Although it is true that radical treatment significantly decreases the risk of death from PC, it is also true that 19 men need to be treated to benefit one man [4, 5]. This arises from the prostate-specific antigen (PSA) screening Era, although the helpfulness of PSA screening still remains debated. Andriole et al. report no mortality benefit from combined screening with PSA testing and digital rectal examination (DRE) during a median follow up of 11 years [6], while Schr？der et al. [7] report that PSA screening without DRE is associated with a 20% relative reduction in the death rate from PC at a median followup of 9 years. However, it remains indubitable that the combined use of PSA and transrectal ultrasound-guided needle biopsy as screening procedure has diagnosed an increasing number of PC, overall at an earlier stage (i.e., low PSA value, grade, and tumour volume) [8]. This has generated several doubts on the risks of overdiagnosis and overtreatment of insignificant neoplastic diseases. It is unclear whether
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