title: Bilaterally positive biopsy cores are associated with non-organ-confined disease in prostate cancer patients eligible for active surveillance.
abstract: OBJECTIVE
  To investigate the association between the laterality of diagnostic prostate cancer-positive biopsy cores and definitive tumor stage on final pathology (organ-confined versus non-organ-confined).
  
  
  METHODS
  This is a retrospective analysis of 165 men after radical prostatectomy fulfilling our active surveillance criteria at the time of surgery. Nominal variables were compared using Fisher's exact test, continuous variables using Mann-Whitney test. Odds ratios including 95% Wald and probabilities including 95% Wilson confidence intervals are provided.
  
  
  RESULTS
  5 (3%) patients had non-organ-confined disease: 2 out of 144 (1%) patients with unilateral and 3 out of 17 (18%) patients with bilateral cancer-positive biopsy cores (p = 0.009). The estimated odds ratio for non-organ-confined disease was 14.67 (95% confidence interval 1.55-189.23) for patients with bilateral compared to patients with unilateral cancer-positive biopsy cores. The sensitivity, specificity and accuracy of bilaterally positive biopsies as an additional criterion to identify non-organ-confined disease are 60, 91 and 90%, respectively.
  
  
  CONCLUSIONS
  In our cohort, patients with bilaterally positive biopsy cores were significantly more likely to harbor a non-organ-confined tumor than patients with unilaterally positive cores. Due to their high specificity, bilaterally positive biopsies may represent a reasonable exclusion criterion for active surveillance if our results are corroborated in further studies.
authors.affiliation: Department of Urology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Umbehr
authors.forename: Remo A
authors.initials: RA
authors.lastname: Largo
authors.forename: Sabrina
authors.initials: S
authors.lastname: Gfeller
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.forename: Cédric
authors.initials: C
authors.lastname: Poyet
authors.forename: Michaela
authors.initials: M
authors.lastname: Paul
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Michael
authors.initials: M
authors.lastname: Müntener
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D057832:Watchful Waiting