Does cumulative prostate cancer length (CCL) in prostate biopsies improve prediction of clinically insignificant cancer at radical prostatectomy in patients eligible for active surveillance?

Abstract

ObjectivesTo evaluate if cumulative prostate cancer length (CCL) on prostate needle biopsy divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer on radical prostatectomy (RP) in patients with prostate cancer eligible for active surveillance (AS). Patients and MethodsPatients diagnosed with prostate cancer on extended (≥10 cores) biopsy with an initial prostate-specific antigen (iPSA) level of <15 ng/mL, clinical stage (cT) ≤ 2a, and highest biopsy Gleason score 3 + 3 = 6 or 3 + 4 = 7 with <3 positive cores who underwent RP were included in the study. The CCL/core and presence of insignificant cancer (organ-confined, volume <0.5 mL, Gleason score at RP ≤6) were recorded. pT2 prostate cancer with RP Gleason score ≤3 + 4 = 7 and volume <0.5 mL were categorised as low-tumour-volume organ-confined disease (LV-OCD). ResultsIn all, 221 patients met the inclusion criteria: the mean age was 59 years and the median iPSA level was 4.5 ng/mL. The clinical stage was cT1 in 86% of patients; biopsy Gleason score was 3 + 3 = 6 in 67% (group 1) and 3 + 4 = 7 in 33% of patients (group 2). The maximum percentage of biopsy core involvement was <50 in 85%; the median CCL/core was 0.15 mm. Insignificant cancer was found in 27% and LV-OCD in 44% of patients. Group 2 was associated with higher number of positive cores, maximum percentage core involvement, total prostate cancer length, and CCL/core. Group 1 was more likely to have insignificant cancer (39%) or LV-OCD (54%) than group 2 (3% and 23%, respectively). Group 2 had significantly higher RP Gleason score and pathological stage. Univariate analysis of group 1 showed that the iPSA level, maximum percentage core involvement, prostate cancer length, and CCL/core were all significantly associated with insignificant cancer and LV-OCD. For group 2, the number of positive cores (1 vs 2) was also significantly associated with LV-OCD. On multivariate logistic regression analysis, maximum percentage core involvement of <50, and number of positive cores (1 vs 2) were independent predictors of insignificant cancer in group 1; biopsy Gleason score, maximum percentage core involvement of <50 and prostate cancer length of <3 mm or CCL/core of <0.2 mm were all independent predictors of LV-OCD in the whole population. The maximum percentage of core involvement of <50 and prostate cancer length of <3 mm or CCL/core of <0.2 mm were also independent predictors of LV-OCD in group 1 patients.

High-volume prostate biopsy core involvement is not associated with an increased risk of cancer recurrence following 5-fraction stereotactic body radiation therapy monotherapy

“…Greatest percentage of a given involved biopsy core length has also been associated with adverse clinical outcomes following prostatectomy [ 23 ]. Higher cumulative PCa core length relative to the number of biopsy cores sampled is associated with identification of higher volume PCa at the time of prostatectomy, though it is unclear if this is confounded by PV [ 24 ].…”

Development and internal validation of a novel nomogram for predicting lymph node invasion for prostate cancer patients undergoing extended pelvic lymph node dissection

“…First, the results of our univariable analyses show that detailed biopsy characteristics, such as the maximum percentage of single core involvement with highest-grade PCa, which represents a predictor of LNI. Several studies also found out the association between variables that can be considered as a proxy of pathologic tumor volume and the risk of adverse prognosis in PCa patients ( 20 , 21 ). Meanwhile, after the inclusion of this covariates, the multivariable model 2 shows better improved the accuracy in predicting LNI compared with the base model including PSA, clinical stage, biopsy gleason grade group ( Table 1 , modle 2 vs modle 1).…”

The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for active surveillance candidates

“…The ability of clinical parameters to predict the presence of indolent disease at final pathology has been widely investigated: age, PSA, PSA density, number of positive core, number of core taken, percentage of biopsy core involved, percentage of grade 4 in the core biopsy, cumulative cancer length and results of previously biopsy were all significant predictors in different studies. 3,4,11,14,[17][18][19] Among the 2494 patients enrolled up to May 2012 in the PRIAS study, PSA density, the number of positive cores and the total number of cores at baseline were all independent predictors of likelihood of being switched to active treatment during follow-up. 2 Chen et al 17 showed that the cumulative cancer length on prostate needle biopsy could predict the presence of indolent disease after radical prostatectomy.…”