As transrectal prostate biopsies are inaccurate the prevalence of clinically significant prostate cancer in men undergoing biopsy is unknown. We determined the impact of different histological thresholds to denote clinically significant cancer in men undergoing a more accurate biopsy, transperineal template prostate mapping.
Multi-centre cross-sectional cohort of men who underwent TPM biopsies between May 2006 and January 2012. Four different thresholds of significance - combining tumour grade and burden - were employed to measure the consequent variation with respect to the prevalence of clinically significant disease.
Of 1,203 men, 17% (199/1203) had no previous biopsy, 38% (455/1203) had prior negative TRUS biopsy, 24% (289/1203) were on active surveillance, and 21% (260/1203) were seeking risk stratification. Mean age was 63. 5 (SD 7. 6) years and median PSA was 7. 4 (IQR 5. 3-10. 5) ng/ml. 35% (424/1203) had no cancer detected. The prevalence of clinically significant cancer varied between 14% and 83% according to the histological threshold used. The prevalence varied between 30% and 51% in men had who had no previous biopsy, between 14% and 27% in men who had prior negative biopsy, between 36% and 74% in men on active surveillance, and between 47% and 83% in men seeking risk stratification.
According to TPM biopsy, between one-in-two and one-in-three men have prostate cancer that is histologically defined as clinically significant. This suggests that the commonly used thresholds may be set too low.
The Journal of urology. 2015 Nov 25 [Epub ahead of print]
M Valerio, C Anele, S R J Bott, S C Charman, J van der Meulen, H El-Mahallawi, A M Emara, A Freeman, C Jameson, R G Hindley, B S I Montgomery, P B Singh, H U Ahmed, M Emberton
Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK. , Department of Urology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK. , Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. , Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. , Department of Histopathology, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, Hampshire, UK. , Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, Hampshire, UK; Department of Urology, Ain Shams University, Cairo, Egypt. , Department of Histopathology, University College Hospital London, London, UK. , Department of Histopathology, University College Hospital London, London, UK. , Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, Hampshire, UK. , Department of Urology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK. , Department of Urology, Royal Free London NHS Foundation Trust, London, UK. , Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK. , Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College Hospitals NHS Foundation Trust, London, UK.