title: Preoperative prediction of pathologically insignificant prostate cancer in radical prostatectomy specimens: the role of prostate volume and the number of positive cores.
abstract: BACKGROUND
  To determine clinical and biopsy features with predictive capacity to identify pathologically insignificant prostate cancer (pIPCa).
  
  
  METHODS
  pIPCa was defined as cancer volume <0.5 cm(3) and a Gleason score (GS) of <or=6 in radical prostatectomy (RP) specimens. Clinical and biopsy parameters were studied as predictors of pIPCa and validated by applying them to d'Amico's low-risk cases: T1c-T2a, prostate-specific antigen (PSA) <10 and biopsy GS <or=6. Appropriate cut-offs were selected.
  
  
  RESULTS
  280 patients were evaluated; 11.8% (33) had pIPCa, increasing to 23% in low-risk cases. In patients fulfilling d'Amico's low-risk criteria, variables significantly different in pIPCa were: volume, number of positive cylinders (NPC), percentage of positive cylinders (%PC), percentage of the most affected cylinder (%MAC) and uni/bilaterality. In these cases, volume and the NPC increased as independent variables on logistic regression and when adding a volume threshold of 45 cm(3) and 1 positive core, specificity reached 95.8%.
  
  
  CONCLUSIONS
  The incidence of pIPCa in RP specimens is relevant, especially in low-risk cases. Prostate volume and NPC are independent predictors of pIPCa. We propose a simple predictive model by adding the features of 1 positive core and volume >or=45 cm(3) to d'Amico's criteria. This allows to preoperatively distinguish between patients that most probably would benefit from radical treatment and patients that might be offered active surveillance.
authors.affiliation: Urology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. carlesx @ yahoo.com
authors.forename: Carles X
authors.initials: CX
authors.lastname: Raventós
authors.forename: Anna
authors.initials: A
authors.lastname: Orsola
authors.forename: Inés
authors.initials: I
authors.lastname: de Torres
authors.forename: Lluís
authors.initials: L
authors.lastname: Cecchini
authors.forename: Enrique
authors.initials: E
authors.lastname: Trilla
authors.forename: Jacques
authors.initials: J
authors.lastname: Planas
authors.forename: Joan
authors.initials: J
authors.lastname: Morote
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D005189:False Positive Reactions; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D012044:Regression Analysis; D012306:Risk