Assessment of pathological prostate cancer characteristics in men with favorable biopsy features on predominantly sextant biopsy.

Abstract

BACKGROUND:

The rate of insignificant prostate cancer (IPCa) is increasing.

OBJECTIVES:

To examine three end points in patients with a single, positive core and no high-grade prostate cancer (PCa) at biopsy, namely (1) rate of clinical IPCa at radical prostatectomy (RP), defined as organ-confined PCa with a Gleason score of 6 or lower and tumor volume<0.5 cc; (2) rate of pathologically unfavorable PCa at RP (Gleason 7-10 or non-organ-confined disease); and (3) ability to predict either insignificant or unfavorable PCa at RP.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective analysis of 209 men with one positive biopsy core showing Gleason 6 or lower.

MEASUREMENTS:

: Detailed clinical and RP data were used in multivariable logistic regression models. Their bias-corrected accuracy estimates were quantified using the area under the curve (AUC) method.

RESULTS AND LIMITATIONS:

At RP, IPCa was present in 28 patients (13.4%) and pathologically unfavorable PCa, defined as Gleason 7 or higher or non-organ-confined PCa, was reported in 70 (33.5%) of 209 men; when Gleason 8 or higher or non-organ-confined PCa was considered, the proportion fell to 11%. Our multivariable models predicting different categories of pathologically unfavorable PCa at RP had an accuracy rate between 56% and 68% for predicting IPCa at RP versus 65.1% to 66.1% and 61.7% for the IPCa nomograms of Kattan et al and Nakanishi et al, respectively. Our data are not applicable to screening because they originate from a referral population.

CONCLUSIONS:

Despite highly favorable biopsy features, between 11% and 33% of men had unfavorable PCa at RP and only a minority (13.4%) had pathologically confirmed IPCa. Neither clinically insignificant nor pathologically unfavorable features could be predicted with sufficient accuracy for clinical decision making.

• Authors: Felix K-H Chun, Nazareno Suardi, Umberto Capitanio, Claudio Jeldres, Sascha Ahyai, Markus Graefen, Alexander Haese, Thomas Steuber, Andreas Erbersdobler, Francesco Montorsi, Hartwig Huland, Pierre I Karakiewicz
• Journal: European urology (Eur Urol) Vol. 55 Issue 3 Pg. 617-28-6 (Mar 2009) ISSN: 1873-7560 [Electronic] Switzerland
• PMID: 18499335 (Publication Type: Journal Article)

Topics

• Aged
• Biopsy, Needle (methods)
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prostatic Neoplasms (pathology)
• Retrospective Studies