When 5 percent or less of the tissue was cancerous, only 17 percent of the men went on to develop more advanced cancer; this is now the classification for stage T1a, or A1, disease. But when more than 5 percent of the resected tissue was cancerous, 68 percent of these men went on to develop cancer progression; this now is the classification of stage T1a, or A2, disease. “It is felt that the amount of cancer in almost all of these patients is significant enough to warrant therapy,” says one of the investigators.
So: Some men with stage T1a cancer require treatment. Some don’t. How to tell the difference? Our old friend PSA comes back to help us again. As it turns out, the level of PSA three months after TUR can be helpful in identifying the men at highest risk of cancer progression. If the PSA is less than 1.o, virtually all of the men with stage T1a (A1) disease have an insignificant amount of cancer. “And we feel that these men can probably be followed with careful digital rectal examinations and PSA tests every six months or a year,” says one of the study’s chief investigators.
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