title: Can we predict real T3 stage prostate cancer in patients with clinical T3 (cT3) disease before radical prostatectomy?
abstract: OBJECTIVE
  Down-staging of clinical T3 (cT3) prostate cancer after radical prostatectomy (RP) is not uncommon due to the inaccuracy of the currently available staging modalities, although selected down-staged cT3 patients can be a candidate for definitive RP. We identified the significant predictors for down-staging of cT3 after RP.
  
  
  METHODS
  We included 67 patients with cT3 stage prostate cancer treated with radical perineal prostatectomy (RPP) between 1998 and 2006 and reviewed their medical records retrospectively. The clinical stage was obtained according to the DRE, the prostate biopsy findings, and the prostate MRI.
  
  
  RESULTS
  Fifty three (79%) patients with cT3 prostate cancer were down-staged to pT2 after RP. The percent of positive cores had the strongest association with down-staging of cT3 [p = 0.01, odds ratio (OR) = 6.3], followed by baseline prostate specific antigen (PSA) (p = 0.03, OR = 5.0), the biopsy Gleason sum (GS) (p = 0.03, OR = 4.7), and the maximum tumor volume of the positive cores (p = 0.05, OR = 4.0). When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores < or = 30%, a maximum tumor volume of the positive cores < or = 75% and GS < or = 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.
  
  
  CONCLUSIONS
  The percent of positive cores < or = 30%, serum PSA < 10 ng/mL, the biopsy GS < or = 7, and the maximum tumor volume of the positive cores < or = 75% were the significant predictors of down-staging cT3 disease after RP.
authors.affiliation: Department of Integrative Bioscience and Biotechnology, Pohang University of Science and Technology, Pohang, Korea.
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Seong Il
authors.initials: SI
authors.lastname: Seo
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.forename: Hyun Moo
authors.initials: HM
authors.lastname: Lee
authors.forename: Han Yong
authors.initials: HY
authors.lastname: Choi
mesh_terms: D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen