Percentage of cancer involvement in positive cores can predict unfavorable disease in men with low-risk prostate cancer but eligible for the prostate cancer international: active surveillance criteria.

Abstract

OBJECTIVES:

To identify predictive factors of unfavorable disease and of biochemical failure in patients treated with radical prostatectomy but eligible for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. We aimed to introduce and validate the percentage of cancer involvement in positive cores (CIPC) as potential worse predictive factor.

METHODS:

From January 2002 to December 2007, 750 consecutive subjects underwent radical prostatectomy at a single institution. We identified 147 (19.05%) patients who were eligible for AS based on PRIAS criteria: clinical stage T1c or T2 disease, prostate-specific antigen level of ≤ 10 ng/ml, Gleason score ≤ 6, prostate-specific antigen-D of<0.2 ng/ml(2), and fewer than 3 positive biopsy cores. CIPC was included in the analysis.

RESULTS:

Of the 147 patients, 95 (66.43%) patients had favorable disease, whereas 48 (33.57%) had unfavorable disease. In multivariate logistic regression, maximum cancer length (odds ratio 12.52, P<0.01) and CIPC (odds ratio 1.70, P<0.01) represented independent predictors of unfavorable prostate cancer. The area under the receiver operating characteristics curve analysis revealed significantly higher performance after including CIPC to the PRIAS criteria (0.61 vs. 0.94, P<0.01). A cutoff of 0.4mm of CIPC was set to predict unfavorable disease with 93% specificity, 76% sensibility, and 87% accuracy based on the receiver operating characteristics curve analysis. Finally, the 3- and 5-years biochemical recurrence (BCR)-free survival were significantly lower in subjects with CIPC ≥ 0.4mm, 88.4 % and 81.0% vs. 97.8% and 95.7%, respectively (P< 0.01).

CONCLUSIONS:

Our findings suggest that the inclusion of CIPC to the prostate biopsy features could be helpful to avoid misclassification in patients eligible for AS according to the PRIAS criteria.

• Authors: Giorgio Ivan Russo, Sebastiano Cimino, Tommaso Castelli, Vincenzo Favilla, Daniele Urzì, Massimiliano Veroux, Massimo Madonia, Giuseppe Morgia
• Journal: Urologic oncology (Urol Oncol) Vol. 32 Issue 3 Pg. 291-6 (Apr 2014) ISSN: 1873-2496 [Electronic] United States
• PMID: 24184119 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Adenocarcinoma (mortality, pathology)
• Aged
• Area Under Curve
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Proportional Hazards Models
• Prostatectomy
• Prostatic Neoplasms (mortality, pathology)
• ROC Curve
• Risk Factors
• Watchful Waiting