Validation of the contemporary epstein criteria for insignificant prostate cancer in European men.
OBJECTIVE
The Epstein criteria represent the most widely used scheme for prediction of clinically insignificant prostate cancer (PCa). However, they were never validated in European men. We assessed the rate of unfavorable prostate cancer (Gleason 7-10 or non-organ-confined disease) in a cohort of 366 men who fulfilled the Epstein clinically insignificant PCa criteria.


METHODS
Between 1996 and 2006, 2580 men underwent radical prostatectomy at a single academic European institution. Of those, 366 fulfilled the contemporary Epstein clinically insignificant PCa criteria. Analyses targeted the rate of pathologically unfavorable prostate cancer, defined as either Gleason sum 7-10 or non-organ-confined disease, or a combination of these characteristics in patients with clinically insignificant PCa.


RESULTS
Gleason 7-10 prostate cancer at radical prostatectomy was found in 88 patients (24%) with clinically insignificant PCa. In addition, 30 (34.1%) of the 88 patients harboured non-organ-confined disease. Consequently, the contemporary Epstein criteria for clinically insignificant PCa were inaccurate in 24% of patients.


CONCLUSIONS
The Epstein clinical insignificant PCa criteria may underestimate the true nature of prostate cancer in as many as 24% of European patients. Therefore, caution is advised when treatment decisions are based solely on these criteria.
Jeldres
Claudio
C
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
Suardi
Nazareno
N
Walz
Jochen
J
Hutterer
Georg C
GC
Ahyai
Sascha
S
Lattouf
Jean-Baptiste
JB
Haese
Alexander
A
Graefen
Markus
M
Erbersdobler
Andreas
A
Heinzer
Hans
H
Huland
Hartwig
H
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology*