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: 3.05). 07/2012; DOI: 10.1111/j.1464-410X.2012.11272.x
Source: PubMed

ABSTRACT 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. 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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    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.
    Urology 10/2013; · 2.42 Impact Factor

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