Preoperative prediction of pathologically insignificant prostate cancer in radical prostatectomy specimens: the role of prostate volume and the number of positive cores.
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.
Raventós
Carles X
CX
Urology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. carlesx @ yahoo.com
Orsola
Anna
A
de Torres
Inés
I
Cecchini
Lluís
L
Trilla
Enrique
E
Planas
Jacques
J
Morote
Joan
J
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