Surgical treatment of stage A2 prostatic carcinoma: significance of tumor grade and extent.

Patients with stage A2 carcinoma of the prostate are a heterogeneous population and not all of them progress to clinically manifest disease. We found a similar variability in terms of the pathological findings in a group of 34 patients with stage A2 disease undergoing pelvic lymphadenectomy and radical prostatectomy. While 8 patients (24 per cent) had metastatic disease on staging lymphadenectomy, 9 patients (27 per cent) had negative lymphadenectomy, with minimal or no residual tumor in the radical specimen. The histologic grade and extent of tumor on transurethral resection did not predict reliably patients with stage A2 disease and minimally invasive cancer at radical prostatectomy. It appears that present criteria for separating stage A tumors into focal and diffuse categories are adequate for selecting therapy for patients with incidental carcinoma of the prostate.