Characteristics of insignificant clinical T1c prostate tumors

Abstract

BACKGROUND The authors examined the cases of men who had undergone radical prostatectomy for low‐volume clinical T1c prostate carcinoma that was judged to be ‘insignificant’ on the basis of previously established preoperative clinicopathologic parameters. Pathologic findings subsequently were analyzed for correlations with extent of disease in an attempt to validate the contemporary usefulness of existing parameters for predicting the ‘significance’ of prostate tumors. METHODS A series of 237 men who had undergone radical prostatectomy for T1c disease between December 2000 and August 2003 was evaluated. Insignificant prostate carcinoma as assessed on biopsy was defined according to the 1994 Epstein criteria, which were as follows: prostate‐specific antigen density < 0.15 ng/mL, Gleason score ≤ 6, fewer than 3 cores containing prostate carcinoma, and ≤ 50% involvement of any core with prostate carcinoma. Postsurgical pathologic findings were analyzed for potential correlations with the Epstein criteria. RESULTS According to the Epstein needle biopsy criteria, organ‐confined prostate carcinoma was detected in 91.6% of all patients, whereas the remaining 8.4% of patients were found to have non‐organ‐confined disease. Comparison of pathologic findings and Epstein biopsy criteria revealed that alteration of the original criteria did not improve the detection of non‐organ‐confined prostate carcinoma. CONCLUSIONS The findings made in the current study suggest that the majority of patients with T1c prostate carcinoma have insignificant disease. Furthermore, it was found that the Epstein criteria for identifying insignificant prostate carcinoma remained a useful tool in the making of treatment‐related decisions. Cancer 2004. © 2004 American Cancer Society.

Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

“…The number of positive cores, the tumour length (total or at any core) and the percent of cancer involvement at any core are predictive factors of tumour volume in RP specimens or biochemical failure after RP [8,[22][23]. The aim of our retrospective study was to compare the rate of misclassification associated with the use of 3 different biopsy criteria [13, [16][17]. For each criterion, we also tested the impact of PSA density on the number of men eligible and the risk of unfavourable disease [van den Bergh, Carter].…”

“…This may represent a bias, the target population for AS being larger than our restricted cohort. In this study, we tested current AS criteria which were internationally used or recently published [Carter,13,[16][17][18]. Our listing of AS criteria was not complete but provided a representative cohort of the men actually included in AS protocols.…”

“…A cancer involvement of <33% of biopsy cores was retained in the UCSF cohort [16]. Other series included cancers involving <3 cores only [14] and with an extent of cancer in any core <50% [13,17]. Recently, a prospective trial of AS (SURACaP trial) has been opened in France including patients with a tumour length <3 mm in <3 cores [18].…”

Using nuclear morphometry to predict the need for treatment among men with low grade, low stage prostate cancer enrolled in a program of expectant management with curative intent

“…With widespread screening, men are diagnosed with CaP at a younger age, exhibit lower stage disease and smaller tumors, and have lower serum PSA, Gleason score 6 or 7, and nonpalpable disease (75%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. While a great number of men are still diagnosed with advanced disease and approximately 25% of all CaP patients detected will recur [2,4,12], approximately 25% of men undergoing PSA testing in referral and screened populations will have well differentiated (Gleason score <7), small volume (<0.5 cc) tumors known to demonstrate a long natural history [8,9,15]. The Epstein criteria, PSA density <0.15 ng/ml/g without adverse biopsy pathology (Gleason score <7, <3 cores involved with cancer, and <50% cancer involving any single core), correctly predict small volume, low grade tumors in 73% of men undergoing radical prostatectomy [8].…”

Formalized prediction of clinically significant prostate cancer: is it possible?

“…8 The criteria were validated in a contemporary cohort of patients and shown to accurately predict organ-confined disease in almost 92% of patients. 9 There are a number of other schema that have been published by various groups seeking to identify patients with organ-confined disease and a low risk of progression that would be suitable for active surveillance ( Table 1).…”