Predicting unilateral prostate cancer based on biopsy features: implications for focal ablative therapy--results from the SEARCH database.
OBJECTIVE
For men with low risk prostate cancer it was recently proposed that ablative treatment to the affected side may decrease morbidity, while maintaining good oncological outcomes. However, few studies have assessed the correlation between biopsy parameters and pathological outcome (unilateral vs bilateral disease).


METHODS
Using the Shared Equal Access Regional Cancer Hospital Database of men treated with radical prostatectomy at multiple equal access medical centers we retrospectively examined the records of 261 men with clinical stage T1c or T2a prostate cancer, prostate specific antigen less than 10 ng/ml, Gleason sum 6 or less and only 1 or 2 ipsilateral positive cores on at least sextant biopsy. We compared clinical characteristics between men with pathologically unilateral disease or less (pT2b or less) and men with pathologically bilateral disease or extraprostatic extension (pT2c or greater). To determine the significant predictors of pT2c or greater disease we used a multivariate logistic regression model.


RESULTS
Of the cohort of 261 men with low risk prostate cancer only 93 (35.1%) had unilateral or no evidence of disease following examination of radical prostatectomy specimens. Men with pathologically unilateral or less disease did not differ from those with bilateral or more advanced disease by age, prostate specific antigen, clinical stage, body mass index or number of positive biopsy cores (1 vs 2). On multivariate analysis no clinical feature was significantly related to pathologically unilateral or less vs bilateral or greater disease.


CONCLUSIONS
The majority of men with low risk prostate cancer and 1 or 2 ipsilateral positive biopsy cores have pathologically bilateral disease. Therefore, strategies for unilateral treatment of prostate cancer are unlikely to be curative for these men.
Scales
Charles D
CD
Department of Surgery (Division of Urologic Surgery), Duke University School of Medicine, Durham, North Carolina 27710, USA.
Presti
Joseph C
JC
Kane
Christopher J
CJ
Terris
Martha K
MK
Aronson
William J
WJ
Amling
Christopher L
CL
Freedland
Stephen J
SJ
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D002173:Cancer Care Facilities; D015331:Cohort Studies; D019992:Databases as Topic; D018450:Disease Progression; D005500:Follow-Up Studies; D006753:Hospital Records; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen