Validation of Epstein criteria of insignificant prostate cancer in Middle East patients.
BACKGROUND
Since introduction of Contemporary Epstein criteria, it has been studied and validated in many countries and nations. However, they were not validated in Middle East patients up till now.


OBJECTIVE
To validate the Contemporary Epstein criteria in Middle East patients.


METHODS
On past 8 years, 70 cases underwent radical prostatectomy for T1c prostate cancer. Contemporary Epstein criteria were applied retrospectively on prostatic biopsies. Among our patients, 35 cases met the criteria for clinically insignificant prostate cancer. Pathological revision of the prostatic biopsies, definitive prostatectomy specimens and re-staging were done by single pathologist. Assessment of recurrence rate was done. Up and down grading of the Gleason scoring was studied.


RESULTS
The preoperative data and biopsy results using the Contemporary Epstein criteria were fulfilled on 35 cases. On definitive pathology; 16 cases (45.7%) had Gleason score >6, while 8.6% of cases are non-organ confined (2 cases and 1 case with extra- capsular and Seminal vesicles infiltrations, respectively). Both lobes were involved in 20 cases. Moreover, 40% (14 cases) showed upgrading of the score. Lymphatic permeation could be recognized in four cases. Mean follow-up time 88.1 months, 8.6% cases develop metastasis.


CONCLUSIONS
Whenever Epstein criteria are applied in Middle East patients, the decision of active surveillance based for clinically insignificant prostate cancer (who met the Epstein criteria) will miss nearly 46% of unfavorable prostate cancer. As well as a risk of later metastasis could be in 8.6% of them.
Hekal
Ihab A
IA
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. eahekal@yahoo.com
El-Tabey
Nasr A
NA
Nabeeh
Mohamed Adel
MA
El-Assmy
Ahmed
A
Abd El-Hameed
Mohamed
M
Nabeeh
Adel
A
Ibrahiem
Elhousseiny I
EI
D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery
D017430:Prostate-Specific Antigen