Prediction of pathological stages before prostatectomy in prostate cancer patients: analysis of 12 systematic prostate needle biopsy specimens.
OBJECTIVE
To identify the most reliable predictor of the pathological stage among multiple parameters obtained by performing systematic biopsies and to assess the predictive value of any identified parameters in combination with the prostate specific antigen and the Gleason scores.


METHODS
We examined 5 biopsy parameters from 12 systematic needle biopsy results in 104 consecutive prostate cancer patients who underwent prostatectomy: the number of cores positive for cancer, percentage of positive biopsy cores, total linear cancer length (absolute sum of tumor length at each core), percentage cancer length (total cancer length divided by total length of cores obtained x100), and maximum cancer core length. The predictive values of these parameters were assessed using multivariate logistic analysis and receiver operating characteristic analysis. We evaluated whether the most reliable biopsy parameter in combination with traditional variables show better predictability of the pathological stage than traditional variables alone by receiver operating characteristic analysis.


RESULTS
Of 104 patients, 85 (82.9%) had organ confined cancer and 19 (17.1%) showed extraprostatic extension. Of the five parameters examined, maximum cancer length was found to best predict pathological staging. Although insignificant, adding results of maximum cancer length to prostate specific antigen and Gleason scores improved predictability. Of 41 patients with a maximum cancer length of <0.9 cm, PSA of <16 ng/mL, and Gleason score of <7, none showed extraprostatic extension.


CONCLUSIONS
The maximum cancer length was found to be the most reliable predictor of disease staging. The findings of a maximum cancer length of <0.9 cm, PSA of <16 ng/mL, and a Gleason score of <7 can suggest an organ-confined disease.
Seoul National University College of Medicine, Seoul National University Bundang Hospital, Institute of Radiation Medicine, Seoul National University Medical Research Center, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Eun-Ah
EA
Park
Hak Jong
HJ
Lee
Kwang Gi
KG
Kim
Seung Hyup
SH
Kim
Sang Eun
SE
Lee
Ghee Young
GY
Choe
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012372:ROC Curve