Article

Extended biopsy based criteria incorporating cumulative cancer length for predicting clinically insignificant prostate cancer

Departments of Urology Pathology, Tokyo Medical and Dental University Graduate SchoolDepartments of Urology Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
BJU International (Impact Factor: 3.13). 07/2012; 110(11B). DOI: 10.1111/j.1464-410X.2012.11272.x
Source: PubMed

ABSTRACT OBJECTIVE To develop extended biopsy based criteria for predicting insignificant cancer (IC) using extended biopsy findings. PATIENTS AND METHODS From 2000 to 2009, 1575 patients with prostate cancer were primarily treated by radical prostatectomy in two referral hospitals. Of these, the study cohort comprised 499 patients with extended biopsy confirmed, clinically organ-confined (cT1-2N0M0) prostate cancer with PSA levels of <20 ng/mL. Cancer information obtained through extended biopsy included cumulative cancer length (CCL) divided by the number of biopsy cores (CCL/core). RESULTS Pathological examination revealed 39 ICs (7.8%). All these ICs fell in a category of prostate cancer with clinical stage <= T2a and 2005 International Society of Urological Pathology Consensus Conference (ISUP) modified biopsy Gleason score <= 7. Accordingly, we analysed predictors of IC in a subset cohort of 370 patients in this category. A multivariate logistic regression analysis revealed that 2005 ISUP modified biopsy Gleason score and CCL/core were independently significant predictors of IC. We determined a threshold value of CCL/core of 0.20 mm for predicting IC using receiver operating characteristic analysis. Based on these findings, we developed simple extended biopsy based criteria for predicting IC as follows: (i) PSA level of <20 ng/mL; (ii) Clinical stage <= T2a; (iii) 2005 ISUP modified biopsy Gleason score <= 6; (iv) CCL/core of <0.20 mm. The specificity of the criteria was 91%, which was significantly higher than the value from a subset of criteria without item iv (P < 0.001). CONCLUSION We have developed extended biopsy based criteria for predicting IC incorporating the 2005 ISUP modified biopsy Gleason score and CCL/core.

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