Critical Assessment Of Tools To Predict Clinically Insignificant Prostate Cancer At Radical Prostatectomy In Contemporary Men

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 07 Aug 2008 - 2:00 PDT

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UroToday.com - In the August 2008 issue of Cancer, Dr. Felix Chun and associates present data to discriminate between men with indolent and important prostate cancer (CaP) to help stratify those electing active surveillance (AS). The authors point out that even the criteria suggested by Dr. Epstein and the nomogram by Dr. Kattan will only have about 80% accuracy at radical prostatectomy (RP) for estimating insignificant prostate cancer (ICaP). The criteria most commonly applied are no more than 2 positive biopsy cores positive with up to 50% cancer involvement, biopsy Gleason sum of 6 or less, and PSA density less than 0.15.

Between 1992 and 2003, clinical and pathologic data prospectively gathered on 1,153 men with CaP who underwent RP at the investigators' institution was used for the analysis. Clinically ICaP was defined as organ-confined disease with total volume <0.5cc without Gleason patterns 4 or 5. Various nomogram probability cutoffs were tested to assess the ability to identify patients with or without ICaP.

The mean and median pretreatment PSA levels were 9.6 and 7.2ng/ml. Clinical stages T1c and T2a accounted for 79.2% of cases. Biopsy Gleason sums of 6, and 7-10 occurred in 56% and 40.5%, respectively. Tumor volumes greater than 0.5cc were recorded in 93.6%. Pathologic criteria of ICaP were fulfilled in 5.7% of patients. Of the ICaP predictors, no statistically significant cutoff was identified for serum PSA. However, 4 cutoffs were identified for the variable defining the length of CaP tissue in the biopsy cores. In multivariate analyses, all examined variables were independent predictors of ICaP at final pathology. After fast backward variable removal PSA, biopsy Gleason sum, cumulative cancer length and percent positive cores remained in the model and contributed to 90.4% accuracy for prediction of ICaP at RP. Application of the Kattan nomogram resulted in an accuracy of 80.6%, overestimating ICaP in this study cohort.

Chun FK, Haese A, Ahyai SA, Walz J, Suardi N, Capitanio U, Graefen M, Erbersdobler A, Huland H, Karakiewicz PI
Cancer. 2008 Jun 13. Epub ahead of print.
doi:10.1002/cncr.23610

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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