Department of Urology, Department of Pathology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b.
To examine potential predictors of pathological outcomes for a single microfocal (≤ 3 mm) positive prostate cancer detected via contemporary biopsy scheme in patients presenting with prostate-specific antigen (PSA) ≤ 10 ng/mL.
We reviewed the data of 119 patients who had prebiopsy PSA ≤ 10 ng/mL and a single microfocal (≤ 3 mm) Gleason ≤ 6 prostate cancer identified via multicore (≥12) biopsy and who subsequently underwent radical prostatectomy (RP). We assessed the rates of insignificant prostate cancer (organ-confined and pathological Gleason ≤ 6 with tumour volume < 0.5 mL) and unfavourable prostate cancer (upstaging and/or upgrading) by analysing pathological findings. Potential preoperative predictors of insignificant or unfavourable prostate cancer were analysed. Multivariable models for predicting insignificant and unfavourable tumours were devised and evaluated.
Overall rates of insignificant and unfavourable prostate cancer were 44.5% and 24.4%, respectively. In multivariate analysis, only PSA density was an independent predictor of insignificant prostate cancer. Predictive accuracies of multivariable models for predicting insignificant prostate cancer did not exceed 68.2%. No significant predictor for pathologically unfavourable tumour was found in multivariate analysis. All versions of the multivariable model devised for prediction of unfavourable tumour showed predictive accuracies ≤ 66.9%.
Although PSA density can be considered an independent predictor of pathologically insignificant tumour among patients with PSA ≤ 10 ng/mL and only a single microfocal tumour detected via multicore (≥12) biopsy, the clinical and biopsy-related parameters that are currently available have limited value in predicting pathologically insignificant or unfavourable prostate cancer in such patients.
Written by:
Hong SK, Na W, Park JM, Byun SS, Oh JJ, Nam JS, Jeong CW, Choe G, Lee HJ, Hwang SI, Lee SE.
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Reference: BJU Int. 2010 Dec 24. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.09996.x
PubMed Abstract
PMID: 21199287
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