Smaller prostate size, more aggressive cancer

In men with prostate cancer, a small prostate size is associated with higher grade, more advanced prostate cancer, and a greater risk of disease progression, according to a new report.

"Prostate cancer with a small prostate is worrisome," said Dr. Stephen J. Freedland, now at Duke University Medical Center, Durham, North Carolina. "These patients might need close follow-up regardless of the treatment they get."

Freedland and colleagues evaluated prostate weight and disease severity among 1602 men with prostate cancer that was treated by surgical removal of the prostate.

After adjusting for age, decreasing prostate weight was associated with increased odds of high-grade disease, incomplete removal of the cancer, and extension of the tumor beyond the gland, the team reports in the Journal of Clinical Oncology.

Smaller prostate weight was also associated with significantly increased risk that PSA levels would begin rising again.

"If a man has prostate cancer, then the size of the prostate can be used to predict its aggressiveness," Freedland said. "I would be a little more hesitant to simply observe a man with a very small prostate. On the contrary, if the man is a candidate for observation alone and has big prostate, I'd be more comfortable with a wait and see approach."

He pointed out that men with prostate cancer who are considering radiation treatment "may want to think more about hormonal manipulation for more aggressive cancers - but it's unclear whether having a small prostate alone is enough to put them into the high risk category."

SOURCE: Journal of Clinical Oncology, October 20, 2005.