Single Prostatic Cancer Foci on Prostate Biopsy

As a consequence of the detection of prostate cancer at an earlier stage, urologists increasingly must deal with the finding of a single small focus of prostatic cancer identified in prostate needle biopsies. Detection of these small cancer foci raises both diagnostic and clinical problems. For pathologists, it may be challenging to make a definite diagnosis of prostate cancer, avoiding confusion with look-alike benign lesions. A small cancer focus may be overlooked or misdiagnosed and consequences may be serious if the missed lesion, in fact, represents a high-grade cancer. Urologists should be aware of a potential variation in the pathologist's threshold to call a cancer despite the introduction of helpful ancillary techniques. For urologists, the finding of a single small focus of prostatic cancer may present a dilemma whether to treat or defer treatment given the limited correlation between biopsy and prostatectomy findings. From a clinical perspective it is important to find means to differentiate between indolent and more aggressive cancers, which may include extensive prostate mapping by numerous biopsies and application of nomograms. Future developments may be that improved imaging techniques would enable an accurate assessment of the actual size of the prostate cancer.