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: 3.53). 07/2012; 110(11B). DOI: 10.1111/j.1464-410X.2012.11272.x
Source: PubMed


Study Type – Prognosis (inception cohort)
Level of Evidence 2
What's known on the subject? and What does the study add?
The criteria used for selecting patients with prostate cancer for active surveillance (AS) are still not satisfactory due to the difficulty in predicting the significance of the prostate cancer.
Urologists could predict insignificant prostate cancer by incorporating cumulative cancer length and biopsy Gleason score, derived from extended biopsy. The present study has added new criteria for predicting insignificant prostate cancer, which would lead to a better selection of candidates for AS.

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Available from: Iwao Fukui, Sep 18, 2014
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    ABSTRACT: To find out which factors could predict the diagnosis of insignificant prostate cancer (ins-PCa) according to a recently updated definition (overall tumor volume up to 2.5 cm(3); final Gleason score ≤6; organ-confined disease) on a prostatic biopsy specimen. This was a retrospective analysis of 210 patients undergoing radical prostatectomy for a cT1c prostate neoplasm with a biopsy specimen Gleason score of ≤6. A logistic regression model was used to assess the differences in the distribution of some possibly predictive factors between the ins-PCa patients, according to the updated definition, and the remaining patients. By applying an updated definition of ins-PCa, the prevalence of this condition increased from 13.3% to 49.5% (104 of 210 patients). The univariate analysis showed a statistically different distribution of the following factors: prostate-specific antigen density, prostate volume, number of cancer-involved cores, and maximum percentage of core involvement by cancer. At the multivariable analysis, the maximum percentage of involvement of the core retained its relevance (27.0% in ins-PCa patients and 43.8% in the remaining patients; hazard ratio, 0.972; P = .046), and a 20% cutoff was detected. In a cohort of patients with PCa cT1c and a biopsy specimen Gleason score of ≤6, the ins-PCa rate, according to the updated definition, is close to 50%, and the percentage of cancer involvement of the core is the single factor that best predicts this diagnosis.
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    ABSTRACT: 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. 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≤10ng/ml, Gleason score≤6, prostate-specific antigen-D of<0.2ng/ml(2), and fewer than 3 positive biopsy cores. CIPC was included in the analysis. 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). 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.
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