title: Assessment of pathological prostate cancer characteristics in men with favorable biopsy features on predominantly sextant biopsy.
abstract: BACKGROUND
  The rate of insignificant prostate cancer (IPCa) is increasing.
  
  
  OBJECTIVE
  To examine three end points in patients with a single, positive core and no high-grade prostate cancer (PCa) at biopsy, namely (1) rate of clinical IPCa at radical prostatectomy (RP), defined as organ-confined PCa with a Gleason score of 6 or lower and tumor volume<0.5 cc; (2) rate of pathologically unfavorable PCa at RP (Gleason 7-10 or non-organ-confined disease); and (3) ability to predict either insignificant or unfavorable PCa at RP.
  
  
  METHODS
  Retrospective analysis of 209 men with one positive biopsy core showing Gleason 6 or lower.
  
  
  METHODS
  : Detailed clinical and RP data were used in multivariable logistic regression models. Their bias-corrected accuracy estimates were quantified using the area under the curve (AUC) method.
  
  
  CONCLUSIONS
  At RP, IPCa was present in 28 patients (13.4%) and pathologically unfavorable PCa, defined as Gleason 7 or higher or non-organ-confined PCa, was reported in 70 (33.5%) of 209 men; when Gleason 8 or higher or non-organ-confined PCa was considered, the proportion fell to 11%. Our multivariable models predicting different categories of pathologically unfavorable PCa at RP had an accuracy rate between 56% and 68% for predicting IPCa at RP versus 65.1% to 66.1% and 61.7% for the IPCa nomograms of Kattan et al and Nakanishi et al, respectively. Our data are not applicable to screening because they originate from a referral population.
  
  
  CONCLUSIONS
  Despite highly favorable biopsy features, between 11% and 33% of men had unfavorable PCa at RP and only a minority (13.4%) had pathologically confirmed IPCa. Neither clinically insignificant nor pathologically unfavorable features could be predicted with sufficient accuracy for clinical decision making.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Sascha
authors.initials: S
authors.lastname: Ahyai
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Andreas
authors.initials: A
authors.lastname: Erbersdobler
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies