Prostate Size May Be Clue to Severity of Cancer

FRIDAY, Feb. 10 (HealthDay News) — The size of a man’s prostate
gland may help doctors predict the severity of his prostate cancer,
according to a new study.

Researchers from the Vanderbilt-Ingram Cancer Center in Nashville,
Tenn., found smaller prostates that produce higher levels of prostate
specific antigen (PSA) in the blood are more often linked to serious forms
of prostate cancer that require aggressive treatment.

“There’s nothing about size that would necessarily predict a bad
outcome. What it’s really about is the ratio of PSA to size, or PSA
density, meaning that a small prostate that is making a lot of PSA is
likely to be due to a bad tumor, whereas a large prostate making a lot of
PSA is likely to be due to benign enlargement of the prostate (BPH),” said
the study’s senior author, Dr. Daniel Barocas, an assistant professor of
urologic surgery, in a university news release.

The study’s authors suggest the findings could help doctors determine
the best course of treatment for patients with prostate cancer. For
instance, low-risk patients with a small prostate might benefit from
aggressive treatment.

In conducting the study, they analyzed about 1,250 cases of prostate
cancer among men who had their prostate gland removed but were considered
to be low-risk because their cancer was classified as low grade.

Within that group, the researchers zeroed in on patients whose risk was
considered so low that they might have qualified for less aggressive
treatment, including watching and waiting. The study found that in 31
percent of cases considered low-risk in pre-surgical analysis, the
prostate cancer was upgraded to more serious once pathologists examined
the tissue removed during surgery. The researchers found men with smaller
prostates were more likely to be among this group.

The study was recently published in the Journal of Urology.

The researchers pointed out that the findings are significant since men
with prostate cancer who are considered low-risk may receive less
aggressive treatment or just be placed under observation.

“Our field suffers from this great confusion because in half of men you
can find prostate cancer in microscopic amounts that may not be clinically
significant and yet it’s the second leading cause of cancer death among
men,” Barocas noted. “The more you look for it, the more you find it but
that doesn’t help us figure out who needs treatment and who doesn’t.”

The researchers cautioned that more accurate tests are still needed to
determine which cancers are actually threatening to patients.

“The imaging for prostate cancer is relatively weak because the disease
tends to be diffuse, rather than growing in what we think of as a tumor —
a spherical nodule. Prostate cancer tends to grow along the glands in a
sort of flat pattern, so it’s a little harder to detect. A better test,
which we don’t yet have, would reliably image or identify where in the
prostate the tumor lies,” Barocas added.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.

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