Pathological Features After Radical Prostatectomy In Potential Candidates For Active Monitoring

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 02 Sep 2007 - 0:00 PDT

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UroToday.com- In a report by Dr. Griffin and associates in the July 2007 early view of the Journal of Urology pathologic features from radical prostatectomy (RP) specimens of low risk prostate cancer (CaP) are assessed. The suggestion is made that up to one-third of these men are under-staged and would be at risk for disease progression if they had chosen active surveillance.

Between 2003 and 2006 664 men underwent RP with prostate biopsy data available. Of these men, 292 had Gleason score <6 (3+3) and 2 or less positive cores ("low-risk"). PSA density (PSAD), PSA velocity (PSAV), and PSA doubling time (PSADT) in addition to RP pathology characteristics were compiled. Of the 292 patients, 239 (82%) had clinical stage T1c disease and the rest had stage T2 CaP. Mean age was 59 years and median PSA was 4.7ng/ml. Regarding PSA variables, PSAD, PSAV, and PSADT were 0.10ng/ml/gm, 0.72ng/ml/year, and 3.56years, respectively. A single prostate biopsy core was positive in 58% of these patients and 2 cores positive in 42%.

In the RP specimens 78 patients (27%) had upgrading of their Gleason score to 3+4=7 (58 men), 4+3=7 (16 men), 4+4=8 (3 men), and 5+4=9 (1man). Of 282 men who had detailed RP data available 22 (8%) met commonly used criteria for "insignificant" CaP. Non-organ confined CaP was more likely to be upgraded on final pathology (43%) compared to organ-confined CaP (24%). Additionally, 47 other men (16%) had adverse pathologic features 22 men with positive surgical margins, 18 men with extracapsular extension, and 7 with both findings. Among men with stage T1c CaP 36 (15%) had non-organ confined disease and there was upgrading in the prostatectomy specimen in 63 men (26%). PSA variables did not prove statistically useful in identifying men who had upgrading or adverse pathologic features.

Overall, the data demonstrate pathologic upgrading in 27% of men with 1 or 2 cores of Gleason score 6 CaP and adverse pathologic features in 16%. In an accompanying comment, Dr. Carver of Johns Hopkins points out that the study is limited by selection bias for patients undergoing surgery, lack of central pathologic review, and inclusion of some men with a PSA >10ng/ml. In reply, the authors reanalyzed the data excluding the 13 men with a PSA level >10ng/ml and the results were unchanged.

Griffin CR, Yu X, Loeb S, Desireddi VN, Han M, Graif T, Catalona WJ

J Urol. ePub: July 16, 2007
DOI: 10.1016/j.juro.2007.05.016

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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