Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

Abstract

Purpose: Single positive core in a prostate biopsy is usually associated with indolent prostate cancer (PCa) and is one of the active surveillance (AS) inclusion criteria. We investigated whether single positive core PCa at biopsy could define an archetype of low-risk disease. Materials and Methods: A total of 1320 consecutive patients were enrolled. Among them, 249 patients with single positive core PCa were followed up, and the clinical and pathological parameters influencing prognosis were analyzed. Results: Out of the 249 patients, 172 (69.0%) had pathological findings ≥ pT2c and 87 (34.9%) had an undergraded Gleason Score (GS) based on the biopsy. Positive surgical margins (PSMs), extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were found in 20.8%, 10.0% and 6.0% of patients, respectively. In a comparative analysis, we found that the PSA level, prostate weight and number of cores at biopsy are essential to correctly predict an indolent PCa. A total of 125 patients (67.3%) with nonpalpable tumors became high-risk tumors (pT2c-T3). Analyzing only nonpalpable tumors with a GS of 6 at biopsy (156 patients), we noted that 106 (67.9% of cT1) progressed from cT1c to pT2c-pT3. Conclusions: Single core PCa have clinically significant disease in the Radical Prostatectomy specimens, with considerable rates of overgrading for the GS, pT2c-pT3, PSMs, EPE and SVI. The treatment plan must be evaluated individually for patients with single core PCa and must take into account other prognostic factors when determining whether a patient should be managed with AS. Can

Active surveillance or radical prostatectomy? Which treatment is best?

“…Samaratunga et al (10) analyzed 58 patients with a single minute focus of GS 6 and reported that 48 (82.75 %) had stage pT2, and 8 (13.8 %) had stage pT3. In another study from Brazil, 87.9 % of the patients with a single positive core of GS ≤ 6 had stage pT2 and 12.1 % had stage pT3 (1). We found similar results in this study.…”

“…Prostate cancer (PCa) is the most common noncutaneous cancer and the second leading cause of cancer death among men in Western countries (1). The widespread use of prostate-specifi c antigen (PSA) screening and ultrasound-guided prostate biopsy protocols have increased the proportion of patients at low-risk for PCa (2).…”

“…The widespread use of prostate-specifi c antigen (PSA) screening and ultrasound-guided prostate biopsy protocols have increased the proportion of patients at low-risk for PCa (2). However, 75 % of the patients have non-palpable tumors, and only 5 % have metastasis at the time of the diagnosis (1). Tumor volume in single positive core may be small and these tumors are expected to be insignifi cant PCa (3).…”

“…Tumor volume in single positive core may be small and these tumors are expected to be insignifi cant PCa (3). Many of these patients have insignifi cant PCa (IPCa) characterized by low volume, early stage and are well differentiated (low Gleason score) making them candidates for active surveillance (AS) or watchful waiting (1). Radical prostatectomy (RP) is a curative treatment for localized PCa, especially in low-risk PCa patients but RP is an overtreatment considering the morbidities, oncologic features and postoperative complications in these patients with IPCa (2).…”

Analysis of risk factors for Gleason score upgrading after radical prostatectomy in a Chinese cohort

“…3,21 Even in patients with PCa with positive single core biopsy, the incidence of postoperative GSU reached 34.9%. 22 GS is the most important indicator to evaluate the biological characteristics of PCa, and it is one of the important reference factors for treatment and prognosis. The pathological GS after RP is closely related to biochemical recurrence (BCR) and disease-free survival (DFS), so the correct evaluation of GS after RP is the key to treatment and prognosis.…”