[Pathological consideration of indolent and clinically non-significant prostate cancer definition]. / Consideraciones anatomopatológicas a la definición de cáncer de próstata indolente y clínicamente insignificante.

ABSTRACT

INTRODUCTION: Serum PSA determination has provoked a great increase of prostatic biopsies and detection of neoplasias that passed inadvertent in the past. When these neoplasias are excised a non-negligible number of them have low biologic aggressiveness and may be considered as indolent or clinically non-significant, so that the possibility of conservative attitude is taken into consideration. OBJECTIVE: How to recognize clinically non-significant carcinomas is one of the main challenges and is based on clinical criteria, but mainly pathological. The objective of this review is to analyze the state of this issue. METHODS: We selected those articles reviewing the topic in a general view over the last ten years. RESULTS/CONCLUSIONS: Trying to be as specific as possible search criteria have been refined to Gleason grade with an increase of Gleason 4 patterns (all cribiform patterns). In cases with two separated foci of carcinoma in the same biopsy core, it has been proposed to include as neoplasia the non-tumoral tissue between them. Obviously, with this there is lower sensitivity and it entails that there is no unanimous agreement (or consensus) about how to establish the criteria of clinically non-significant carcinoma. Therefore, once again, it is completely mandatory that urologists and pathologists work together, and while no consensus is reached both must know perfectly the guidelines of the center they work in.