Does cumulative prostate cancer length in prostate biopsies improve prediction of clinically insignificant cancer at radical prostatectomy in patients eligible for active surveillance? - Abstract

OBJECTIVES: To evaluate if cumulative cancer length on prostate needle biopsy (Bx) divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer (IC) on radical prostatectomy (RP) in patients with prostate cancer (PCA) eligible for active surveillance (AS).

MATERIALS AND METHODS: Patients diagnosed with PCA on extended (≥10 cores) Bx with initial prostate-specific antigen (iPSA) < 15 ng/mL, clinical stage (cT) ≤ 2a, and highest Bx Gleason score (BxGS) 3+3=6 or 3+4=7 with < 3 positive cores who underwent RP were included in the study. CCL/core and presence of IC (organ-confined, volume < 0.5 mL, RPGS ≤ 6) at RP were recorded. pT2 PCA with RPGS ≤ 3+4=7 and volume < 0.5 mL were categorized as low-volume organ-confined disease (LV-OCD).

RESULTS: 221 patients met the inclusion criteria: mean age was 59 years, median iPSA was 4.5 ng/ml. Clinical stage was cT1 in 86% of cases; BxGS was 3+3=6 in 67% (group 1) and 3+4=7 in 33% of patients (group 2). Maximum percent of Bx core involvement was < 50 in 85%; median CCL/core was 0.15 mm. IC was found in 27% and LV-OCD in 44% of patients. Group 2 was associated with higher number of positive cores, maximum percent core involvement, total PCA length, and CCL/core. Group 1 was more likely to have IC (39%) or LV-OCD (54%) compared to group 2 (3% and 23%, respectively). Group 2 had significantly higher RPGS and pathologic stage. Univariate analysis of group 1 demonstrated that iPSA, maximum percent core involvement, PCA length, and CCL/core were all significantly associated with IC and LV-OCD; for group 2, number of positive cores (1 versus 2) was also significantly associated with LV-OCD. On multivariate logistic regression analysis, maximum percent core involvement < 50, and number of positive cores (1 vs. 2) were independent predictors of IC in group 1; BxGS, maximum percent core involvement < 50 and PCA length < 3 mm or CCL/core < 0.2 mm were all independent predictors of LV-OCD in the whole population. Maximum percent of core involvement < 50 and PCA length < 3 mm or CCL/core < 0.2 mm were also independent predictors of LV-OCD in group 1 patients.

CONCLUSION: In patients eligible for AS, CCL/core < 0.20 mm was significantly associated with IC and LV-OCD. However, when parameters of cancer burden were considered, CCL/core did not independently add any additional value for predicting IC in patients with BxGS6. CCL/core was an independent predictor of LV-OCD in the whole population and in group 1 patients, although the model including PCA length showed slightly higher AUC.

Written by:
Chen DJ, Falzarano SM, McKenney JK, Przybycin CG, Reynolds JP, Roma A, Jones JS, Stephenson A, Klein E, Magi-Galluzzi C.   Are you the author?
Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH.

Reference: BJU Int. 2014 Jul 25. Epub ahead of print.
doi: 10.1111/bju.12880

PubMed Abstract
PMID: 25060664 Prostate Cancer Section







Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.