pT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies

다국어 초록 (Multilingual Abstract)

Purpose: Often, a diagnosis of pT3 is made on the basis of radical retropubic prostatectomy specimens, despite a Gleason score of 6 on the preoperative prostate biopsy. Thus, we investigated the preoperative variables in patients displaying these characteristics.
Materials and Methods: Study subjects comprised patients at our institute from 1996 to July 2010 who had exhibited a Gleason score of 6 on their prostate biopsies and had undergone a radical retropubic prostatectomy. Through univariate and multivariate analysis, we investigated pT3 predictive factors including age, preoperative prostate-specific antigen (PSA) levels, transrectal ultrasonography (TRUS)-weighted prostate volume, digital rectal examination findings, bilaterality via prostate biopsy, prostatic cancer in prostate base cores via prostate biopsy, maximum length and percent of prostatic cancer, and number of cores detected in prostatic cancer via prostate biopsy.
Results: In the univariate logistic regression mode, a PSA value of 7.4 ng/ml or higher, TRUS-weighted PSA density of 0.2 ng/ml/cc or higher, prostate cancer detected in the basal core, and prostate cancer detected in 2 or more cores out of 12 were predictive factors for extraprostatic extension. Independent predictive factors for stage pT3 were a PSA of 7.4 ng/ml or higher and prostate cancer detected in 2 or more cores out of 12.
Conclusions: In the case of patients with the foregoing risk factors, it is advisable not to perform nerve-sparing surgery but to prepare for the possibility of a pT3 stage.

참고문헌 (Reference)

1 Naya Y, "Tumor length and location of cancer on biopsy predict for side specific extraprostatic cancer extension" 171 : 1093-1097, 2004

2 Cupp MR, "The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy specimen on an individual basis" 153 : 1543-1548, 1995

3 Shah O, "The New York University nerve sparing algorithm decreases the rate of positive surgical margins following radical retropubic prostatectomy" 169 : 2147-2152, 2003

4 구자현, "Significance of Predicted Tumor Volume as a Predictor of Pathologic Stage in Patients Undergoing Radical Prostatectomy" 대한비뇨기과학회 52 (52): 24-30, 2011

5 Elliott SP, "Sextant prostate biopsies predict side and sextant site of extracapsular extension of prostate cancer" 168 : 105-109, 2002

6 Freedland SJ, "SEARCH Database Study Group. Upgrading and downgrading of prostate needle biopsy specimens: risk factors and clinical implications" 69 : 495-499, 2007

7 Partin AW, "Radical prostatectomy for high grade disease: a reevaluation 1994" 151 : 1583-1586, 1994

8 Berglund RK, "Radical prostatectomy as primary treatment modality for locally advanced prostate cancer: a prospective analysis" 67 : 1253-1256, 2006

9 문성진, "Predictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy" 대한비뇨기과학회 51 (51): 677-682, 2010

10 Tsuzuki T, "Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination" 173 : 450-453, 2005

11 Ohori M, "Predicting the presence and side of extracapsular extension: A nomogram for staging prostate cancer" 171 : 1844-1849, 2004

12 Loeb S, "Pathological characteristics of prostate cancer detected through prostate specific antigen based screening" 175 : 902-906, 2006

13 D'Amico AV, "Pathologic findings and prostate specific antigen outcome after radical prostatectomy for patients diagnosed on the basis of a single microscopic focus of prostate carcinoma with a gleason score ≤7" 89 : 1810-1817, 2000

14 Mian BM, "Outcome of patients with Gleason score 8 or higher prostate cancer following radical prostatectomy alone" 167 : 1675-1680, 2002

15 Manoharan M, "Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of ≥8" 92 : 539-544, 2003

16 Epstein JI, "Nonpalpable stage T1c prostate cancer: Prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings" 160 : 2407-2411, 1998

17 Allsbrook WC Jr, "Interobserver reproducibility of Gleason grading of prostatic carcinoma: Urologic pathologists" 32 : 74-80, 2001

18 Divrik RT, "Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens" 25 : 376-382, 2007

19 Emiliozzi P, "Increased accuracy of biopsy Gleason score obtained by extended needle biopsy" 172 : 2224-2226, 2004

20 Magheli A, "Impact of patient age on biochemical recurrence rates following radical prostatectomy" 178 : 1933-1937, 2007

21 San Francisco IF, "Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy" 169 : 136-140, 2003

22 Taneja SS, "Does site specific labeling of sextant biopsy cores predict the site of extracapsular extension in radical prostatectomy surgical specimen" 162 : 1352-1357, 1999

23 Terris MK, "Determination of prostate volume by transrectal ultrasound" 145 : 984-987, 1991

24 Allan RW, "Correlation of minute (0.5 mm or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density" 170 : 370-372, 2003

25 Kupelian P, "Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer" 48 : 249-260, 1996

26 Cookson MS, "Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications" 157 : 559-562, 1997

27 Shinohara K, "Comparison of prostate-specific antigen with prostate-specific antigen density for 3 clinical applications" 152 : 120-123, 1994

28 Graefen M, "A validated strategy for side specific prediction of organ confined prostate cancer: a tool to select for nerve sparing radical prostatectomy" 165 : 857-863, 2001