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Urology. 2004 Sep;64(3):544-50.

Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population?

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  • 1Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

Abstract

OBJECTIVES:

To assess the capacity of several clinical and needle biopsy pathologic parameters to predict insignificant and advanced prostate carcinoma (CaP) in radical prostatectomy tissue from men enrolled in a prostate-specific antigen screening program.

METHODS:

We captured multiple clinical variables and measures of needle biopsy tumor extent from 152 men with Stage T1c CaP with a mean of six biopsy cores who were treated with radical prostatectomy. Insignificant CaP was defined as a tumor volume of less than 0.5 cm(3) that was organ confined with a Gleason score less than 7. Advanced CaP was defined by a formula that combined the Gleason score, pathologic stage, and margin status. Bivariate and logistic regression analyses were used to identify variables predictive of either insignificant or advanced CaP.

RESULTS:

Of the cases of CaP, 25.7% were pathologically insignificant, and 14.5% were pathologically advanced. The best model for predicting insignificant CaP was less than 10% tumor as the greatest percentage of carcinoma in any core and a biopsy Gleason score of less than 7, yielding a sensitivity of 76.9% and specificity of 75.2%. For predicting advanced CaP, the best model was a total biopsy length of CaP greater than 3 mm, Gleason high-grade pattern 4 or 5 disease, perineural invasion in the biopsy, and more than one in six biopsy cores containing CaP, yielding a sensitivity of 13.6% and specificity of 100%.

CONCLUSIONS:

The prediction of insignificant and advanced CaP on an individual basis in patients from a prostate-specific antigen screening study is a challenging problem. However, several histopathologic features of CaP in needle biopsy tissue contain useful information about the severity of disease.

PMID:
15351590
[PubMed - indexed for MEDLINE]
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